BACP Therapy Today April 2022 by Think Publishing

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APRIL 2022 | VOLUME 33 | ISSUE 3 THERAPY TODAY

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When people come to therapy, they bring their family with them

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APRIL 2022 | VOLUME 33 | ISSUE 3

Riding the waves Assessing the impact of the post-pandemic mental health tsunami

The myth of the ‘good white counsellor’ // Trauma-informed therapy for displaced people Why every therapist needs a clinical will // The ethics of working with adopted clients

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Contents April 2022

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Upfront

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Welcome News round-up CPD and events From the Chair Reactions Obituaries From the Editorial Board The month

Main features

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‘I approach a culturally sensitive psychotherapy session as a journey into the unknown – a rich, unexplored territory’ Anthea Kilminster (‘Journey into the unknown’, pages 34–37)

Regulars

It changed my life My practice Talking point The bookshelf Dilemmas Analyse me On the cover..

The big issue

Opportunities

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The big issue Catherine Jackson explores the lasting impact of the pandemic on mental health The big interview Psychotherapist Julia Samuel talks about the themes in her new book on families With the best will in the world Michael Toller explores the ethics of making and maintaining a clinical will Journey into the unknown Anthea Kilminster offers a culturally sensitive approach to working with traumatised displaced people ‘My magic mushroom trip gave me a new understanding of my fears’ Judy Hanley describes a therapeutic psilocybin retreat The myth of the good white counsellor Believing that you ‘don’t see colour’ doesn’t absolve you of racism, says Ruth Smith

Can services cope with the predicted post-COVID mental health tsunami? asks Catherine Jackson (pages 20–24)

Classified, mini ads, recruitment, CPD

British Association for Counselling and Psychotherapy Board and officers Chair Natalie Bailey President David Weaver Deputy Chair Michael Golding Governors Sekinat Adima, Punam Farmah, Julie May, Kate Smith, Vanessa Stirum Chief Executive Hadyn Williams Deputy Chief Executive and Chief Professional Standards Officer Fiona Ballantine Dykes Chief Operations and Membership Officer Chelsea Shelley Interim Chief Operations and Membership Officer Adam Pollard

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5 6 10 11 12 14 16 18

20 26 30 34 38 42

25 41 46 48 50 74

Company limited by guarantee 2175320 Registered in England & Wales. Registered Charity 298361 BACP and the BACP logo are registered trade marks of BACP

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practice – that it’s the most vulnerable This page is one in our society who have been most impacted. In this article, we ask what of the last to go to press, needs to happen now to minimise which allows me to the effects. In our ‘Big interview’, Julia Samuel, acknowledge, if only in therapist, author and BACP Vice a small way, the horrors President, talks to Catherine Jackson about her new book, Every Family Has experienced by the a Story. As a parent myself, I’d like to applaud Julia’s honesty in admitting she people of Ukraine and has had to learn to forgive herself for the anxiety and concern the mistakes she has made as a parent, that are affecting us all just as she forgives her own parents. I’d also like to thank Michael Toller for his ‘Best practice’ article, which simplifies the process involved in making a clinical will (pages 30–32). In our ‘Experience’ piece, therapist Judy Hanley shares her account of taking psilocybin – or magic mushrooms – (legally) at a guided therapeutic retreat overseas. And on pages 42–45, Ruth Smith puts a challenging question to readers: do you fit her description of the ‘good white counsellor’ and are you willing to do the work to challenge this in yourself? That work is certainly an ongoing process for me. I’d love to hear your responses to this, and to all the articles in this issue – do email us at therapytoday@thinkpublishing.co.uk Sally Brown Editor

Contributing to Therapy Today We welcome submissions from practitioners. Please send your article or an email describing what you would like to write about to therapytoday@thinkpublishing.co.uk. Please note, we currently do not publish poetry. For further guidelines, see www.bacp.co.uk/bacp-journals/author-guidelines

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WILL AMLOT

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he long lead time still required to produce a print publication means that we can’t always be responsive to news. I know it must seem odd at times when your magazine lands on your doormat and does not seem to acknowledge significant events happening in the world. The invasion of Ukraine happened at the end of our production process, when most of the content was finalised, edited and designed. This page is one of the last to go to press, which allows me to acknowledge, if only in a small way, the horrors experienced by the people of Ukraine and the anxiety and concern that are affecting us all. As a helping profession, and as human beings, our instinct is to want to do something, which makes Anthea Kilminster’s article on providing culturally sensitive, trauma-informed counselling for displaced people, written before the recent events, seem all the more pertinent. She shares how the Yorkshire-based service, Solace, has supported displaced people from around the world, including Syria and Iraq. The thousands of people fleeing Ukraine will join the estimated 70 million already displaced worldwide, greater than the total population of the UK. A number will make their way to the UK, and counsellors like Anthea will be there to help them adjust. You can read about that vital work on pages 34–37. Our cover theme, the ‘Big issue’ report ‘Riding the waves’ (pages 20–24), assesses the impact of the predicted post-COVID mental health tsunami and confirms what many of us know from our own

Editor Sally Brown e: sally.brown@thinkpublishing.co.uk Art Director George Walker Copy Editor Catherine Jackson Managing Editor Marion Thompson Consultant Editor Rachel Shattock Dawson Reviews Editor Jeanine Connor Production Director Justin Masters Client Engagement Director Rachel Walder Executive Director John Innes Commercial Partnerships Director Sonal Mistry d: 020 3771 7247 e: sonal.mistry@thinkpublishing.co.uk Editorial Advisory Board Luan Baines-Ball, John Barton, Kathy Carter, Jane Czyselska, Jessie Emilion, Dwight Turner, Christa Welsh. For more details, see bit.ly/3ul8uWb Sustainability Therapy Today is printed on PEFC certified paper from sustainably managed forests and produced using suppliers who conform to ISO14001, an industrial, environmental standard that ensures commitment to low carbon emissions and environmentally sensitive waste management. Both the cover and inner pages can be widely recycled.

Therapy Today is published on behalf of the British Association for Counselling and Psychotherapy by Think Media Group, 20 Mortimer Street, London W1T 3JW. w: www.thinkpublishing.co.uk Printed by: Walstead Roche ISSN: 1748-7846 Subscriptions Annual UK subscription £76; overseas subscription £95 (for 10 issues). Single issues £8.50 (UK) or £13.50 (overseas). All BACP members receive a hard copy free of charge as part of their membership. t: 01455 883300 e: bacp@bacp.co.uk Changed your address? Email bacp@bacp.co.uk BACP BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire LE17 4HB t: 01455 883300 e: bacp@bacp.co.uk w: www.bacp.co.uk

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Disclaimer Views expressed in the journal and signed by a writer are the views of the writer, not necessarily those of Think, BACP or the contributor’s employer, unless specifically stated. Publication in this journal does not imply endorsement of the writer’s views by Think or BACP. Similarly, publication of advertisements and advertising material does not constitute endorsement by Think or BACP. Reasonable care has been taken to avoid errors, but no liability will be accepted for any errors that may occur. If you visit a website from a link in the journal, the BACP privacy policy does not apply. We recommend that you examine privacy statements of any third-party websites to understand their privacy procedures. Case studies All case studies in this journal, unless otherwise stated, are permissioned, disguised, adapted or composites, to protect confidentiality.

Copyright Apart from fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright, Designs and Patents Act 1998, no part of this publication may be reproduced, stored or transmitted in any form by any means without the prior permission in writing of the publisher, or in accordance with the terms of licences issued by the Copyright Clearance Centre (CCC), the Copyright Licensing Agency (CLA), and other organisations authorised by the publisher to administer reprographic reproduction rights. Individual and organisational members of BACP may make photocopies for teaching purposes free of charge, provided these copies are not for resale. © British Association for Counselling and Psychotherapy

BACP and the BACP logo are registered trade marks of BACP

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FROM THE CEO

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We recently hosted an online roundtable with the Minister and Shadow Minister for Mental Health and several other advocates for mental health. The event was held in partnership with Mind in London, and served as an opportunity to call on the Government and policy makers in London to invest in counselling and psychotherapy. We were also able to advocate for you, our highly skilled and qualified members, and your role in supporting communities in the capital during their recovery from the COVID-19 pandemic. You can read more about this event in our Chair’s column on page 11 and in the ‘Big issue’ report (pages 20–24). The six collaborative partners of the Scope of Practice and Education (SCoPEd) partnership recently published the January 2022 version of the SCoPEd framework. It is a major step forward for our members and the wider counselling and psychotherapy professions, but it’s important for me to reinforce that this work is about evolution, not revolution, and nothing changes at this stage for BACP or our members. You can find the framework on our website at www.bacp.co.uk/ scoped and read more about the progression routes for SCoPEd on this page. Finally, I’m pleased to share an update on the findings from our workforce mapping survey, which continues to be an extremely valuable source of feedback for us. Find out more on page 8. Hadyn Williams BACP CEO

SCoPEd framework: next steps The January 2022 version of the groundbreaking SCoPEd framework has been published by the SCoPEd partnership. The framework maps the current reality of the core training, practice and competence requirements for counsellors and psychotherapists working with adults. If the BACP Board chooses to adopt SCoPEd, we would expect little to change for registered and accredited members, as the entry points for columns A and B in the SCoPEd framework already align to our registered and accredited membership categories respectively. Our current senior accredited members would typically align to columns B or C, but the entry points for these columns don’t exactly match with the existing criteria for our five different senior accredited schemes. We’re currently looking at this in more detail to ensure that the specialisms and expertise of our all our members, including senior accredited members, would be recognised appropriately if the Board takes the decision to adopt the framework.

Progression routes We believe that having transparent and flexible mechanisms to move between membership categories and columns would make it easier for all members to progress, including those from diverse backgrounds and marginalised and disadvantaged communities. We’re using the potential adoption of SCoPEd as an opportunity to look at how to best create more flexible and inclusive routes to enable members to move from one membership category to another if they wish to, ensuring that these consider

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training and CPD alongside existing skills and experience. So, while some trainings would continue to offer direct entry to column B or C, there would be new mechanisms to support and recognise members who gain skills, knowledge and experience via other routes. All current training, skills and experience would still be valid. Nobody would be asked to ‘start again’, repeat anything or change the way they currently work.

Partnership activity

This would reflect the joint work we are doing with our partners in SCoPEd, which includes: ¬ a jointly commissioned and independently conducted impact assessment ● creating a set of shared principles based around fairness, inclusion and transparency, in preparation for potential implementation ¬ working towards agreed shared titles, and ¬ agreeing transparent and evidencebased mechanisms for members to progress between the columns of the framework as they develop their training, skills, knowledge and experience throughout their professional journey. We’ll be keeping members up to date and creating more opportunities for members to engage and ask questions as this work progresses. For more details, see www.bacp.co.uk/scoped

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mInutes with… Louise Hemmings

Describe your role at BACP:

With a team of three colleagues, my role is to oversee and support the value of BACP’s overall member proposition by ensuring that there is a relevant range of cost-effective products and services for members.

What was the last book you read? What’s the best thing about working at BACP? Working with

Louise Hemmings

people who are passionate about what they do and endeavouring to provide the best possible service to our members. I have been at BACP for just over a year and joined when everyone was working from home due to COVID. Despite this, I was warmly welcomed and soon settled in.

What gets you up in the morning?

BACP Product Manager

challenges I was going through. The ones that really stick in my mind are, ‘If you want to fly, give up whatever weighs you down’, ‘Trust your gut feeling’, and ‘Taking care of yourself makes you stronger for everyone in your life’.

My black Labrador, Buddy, for early morning walks, come rain or shine. While a few extra moments snuggled up in bed would sometimes be nice, after a brisk walk or run, I am ready to face whatever the day brings. What advice would you give to your younger self? All our life

experiences are lessons that make us stronger and more self-aware. I would also say be kind to yourself and do what is right for you, rather than trying to please other people or doing something because you think you should! Best advice you’ve been given?

My lovely mum was always quoting motivational sayings that would enable me to reflect on whatever

Create Magic by Jason Vale, which is ‘a little sprinkle of inspiration’ about the easiest way to experience magic in every area of your life and how to create it. It’s a quick and easy read for anyone who wants to feel uplifted and reminded of the simple things in life that make you happy. What’s your go-to karaoke song?

I’m not a singer, so it would have to be a song that my friends and family could sing along to, such as Meat Loaf’s ‘Paradise by the Dashboard Light’. Your proudest achievement? First and foremost, my twins, Rose and Ashton, who have grown up to be really lovely, caring young people. My other accomplishments have been co–authoring a textbook for City & Guilds, and running two marathons consecutively over two days, although there was some staggering with cramped legs on the second day! What would you like to achieve over the next year? Some form of

‘normality’ following the pandemic. And I’d love to go on a retreat for some total rest, relaxation and meditation in order to recharge body and soul.

PROFESSIONAL CONDUCT

As part of our ongoing strategy to promote the work of counselling and psychotherapy, our CEO Hadyn Williams wrote to The Guardian calling for more investment in counselling and psychotherapy to help meet the increased demand on mental health services. In the published letter to the editor, Hadyn said that the mental health workforce needed to be expanded, and that thousands of trained and skilled counsellors and psychotherapists were ready now to support the country’s recovery from the pandemic. ‘We’re committed to increasing access to therapy services. We now need the Government and those who fund counselling services to match that commitment to enable the recruitment of more counsellors and psychotherapists,’ he said. Hadyn also featured in The Sunday Telegraph, in an article about the increasing numbers of people having therapy. The article included our research showing that the number of people in the UK who have consulted a counsellor or psychotherapist increased from 21% in 2010 to 33% by 2021.

www.bacp.co.uk/about-us/protecting-the-public/ bacp-register/governance-of-the-bacp-register

¢ BACP’s Public Protection Committee holds delegated responsibility for the public protection processes of the Register. You can find out more about the Committee and its work at

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Hadyn Williams in the news

¢ BACP’s Professional Conduct Notices can be found at www.bacp.co.uk/professional-conduct-notices

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Workforce mapping survey

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Members in the media The rise in the number of people seeking counselling and psychotherapy, relationships and exam stress were among the topics our members have been talking about in the media.

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Last October, we shared the initial findings from the first six months of our workforce mapping survey. We’re now pleased to share the updated findings from the first full year of feedback. The workforce mapping survey is emailed to members following their annual membership renewal and over the first 12 months has been sent to approximately 74% of our membership. The survey has received a response rate of around 10% and your feedback will help us to develop and improve our knowledge of your current working practices. It also helps support our policy and advocacy

Lyndsey Baxter and Gordon Knott were interviewed by the BBC for a feature examining mental health support for children, while Ruth Micallef spoke to the BBC about soulmates and the perfect relationship. • Anjula Mutanda spoke to The Sun about ‘weaponised incompetence’ in relationships. Arabella Russell was interviewed by The Guardian about discussing managing money with your partner. Deone Payne-James was interviewed by Riposte magazine about so-called struggle love. Anthony Davis shared his expertise with the Daily Express in an article on the disparity between the mental and physical health of LGBTQ+ people and their heterosexual peers. Gary Bloom • spoke to the Daily Mirror and the Local TV network about footballers’ mental health and the need for them to access therapy. Lara Waycot offered advice to people anxious about returning to ‘normal life’ after the lifting of coronavirus restrictions, which was syndicated by the Press Association and used by more than 75 regional publications and websites. Niki Gibbs, co-chair of our school-based counselling expert reference group, spoke to The Daily Telegraph about whether children are tested too much. The article also highlighted our campaign for a paid counsellor in every school. Exam stress and how to overcome it was a topic discussed by • Alison Hotchkiss with the patient. info website. Patient.info also spoke to Lindsay George and Hansa Pankhania for a feature on the mental health benefits of reading, and to Nicola Vanlint and William Pullen for a piece on overcoming gym anxiety. Katerina Georgiou spoke to Metro about work-related stress, while Armele Philpotts • shared her expertise in an advice column for family-related problems in The Guardian. Juulia Karlstedt offered advice on money and mental health in The Big Issue, and Philip Karahassan spoke on the same theme in Metro. Philip also contributed to a piece for Yahoo! News looking at male grief. Emma Palmer discussed ecotherapy in Psychologies magazine, while Emma Brand spoke about the value of counselling in a feature for Inspire, the Versus Arthritis magazine, about protecting your mental health.

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work, by enabling us to identify gaps in provision and make a stronger case for support with policy makers and commissioners. The results provide key findings in areas such as professional role, annual income, paid, unpaid and voluntary hours, the four nations and additional paid work. We’ve also been able to report on findings in relation to equality, diversity and inclusion, such as ethnicity, age, disabilities, gender, sexual orientation and language. For more about the findings, see www.bacp.co.uk/aboutus/about-bacp/20202021-workplacemapping-survey

New bereavement journal Cruse, the UK’s leading bereavement charity and a BACP strategic partner, has launched Bereavement: journal of grief and responses to death, a new, open-access, peer-reviewed online resource. The journal aims to be a diverse, inclusive, internationally relevant space, inviting critical reflection on key issues in bereavement research and practice. Leading bereavement experts will explore the best current practices and innovations in service delivery and diverse forms of support. In the first issue, BACP Vice President Julia Samuel, psychotherapist and author, reflects on her work supporting an intensive care team during the height of the pandemic. Submissions are welcome from new contributors. See www.bereavementjournal.org/index.php/bcj

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News round-up

Working for you

AdaPT update

¬ We held a roundtable

in partnership with Mind in London, which focused on the impact of COVID-19. Both the Mental Health Minister and Shadow Mental Health Minister attended and personally thanked our members for their work during the pandemic. We’ll build on the productive discussions at this event by continuing to champion the profession among decision makers and to lobby the Government to include counselling and psychotherapy in their vision to Build Back Better from the pandemic. ¬ We’re pleased to have been

invited to contribute to the UK Commission on Bereavement, launched in 2021, through a roundtable discussion on how we can work together to improve support for bereaved people. We believe investment is needed for comprehensive bereavement support in all nations of the UK that provides the right support at the right time, including counselling, for those who need it.

the attention of the Education Department our updated recommendation of 90 minutes per month, which has been agreed by the Department. However, some documents shared with schools still include the incorrect guidance. Members working as part of the pilot are advised to follow BACP supervision guidelines as outlined in the Ethical Framework.

¬ The BACP policy team

¬ Building on our work

continues to offer guidance to the Northern Ireland Education Department regarding the supervision needs of primary school counsellors employed as part of the Healthy Minds pilot. BACP has brought to

around rural mental health, which includes the launch of dedicated counselling for farm workers, we were invited to attend an online workshop to discuss the findings of a 12-month project on farming mental health support

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through, and beyond, COVID-19. The event was attended by political representatives from across the four nations, including MP Neil Parish, Chair of the Environment, Food and Rural Affairs Committee, and Lynne Neagle, Welsh Deputy Minister for Mental Health and Wellbeing. We made a strong case for our counselling workforce and its ability to help address the mental health challenges faced by rural workers. We also hosted a special session on ‘Supporting the Mental Health Crisis in Farming’, featuring presentations and a Q&A panel, at the annual Health and Wellbeing at Work Conference in Birmingham in March.

In 2018, we launched a project to support members working in private practice to collect routine outcome measures using an online platform: Advancing Practice through Tracking (AdaPT). However, we’ve made the decision to close the project from 31 July 2022. There have been many positives: members have found using outcome measures and the online platform itself to be acceptable and useful to their practice, and it’s helped facilitate the process of reviewing client feedback with clients. However, there have also been some barriers, including technical issues and the dual consent process that is specific to this project. We’ve made this decision because, although we know that many of you found the online platform (Pragmatic Tracker) and outcome measures very valuable in your work, the project didn’t meet all its aims. But we want to stress that this isn’t the end of the work we’ll be doing as part of our wider aspiration to support members who wish to use routine outcome measures in their practice. We’ll communicate any future initiatives through Therapy Today and our member eBulletin. For more details, please read the project’s threeyear summary report here: www.bacp.co.uk/about-us/ advancing-the-profession/ research/pragmatic-tracker • For further information, contact research@bacp.co.uk

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Don’t miss the Research Conference

Working with clients transitioning in the workplace

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This year’s Research Conference, ‘Striving for equality, diversity and inclusion in research, practice and policy’, is co-partnered with Abertay University and is returning as a hybrid event on Thursday 19 and Friday 20 May 2022. You can either attend in person at the venue in Dundee for one or both days, or join us online, with two dedicated livestream strands. Across the two days, there will be three keynote presentations, along with research papers, lightning talks, poster presentations and symposia as well as discussions and methods

CLIENT

workshops. In-person delegates also have the opportunity to join a networking dinner on the evening of Thursday 19 May. Online delegates can network online with peers, send questions to presenters and listen to dedicated interviews with the keynote speakers, presenters and studio hosts facilitating the day. Both online and in-person delegates will be able to access the on-demand service until August 2022, to catch up on any content missed. For more information and to book, see www.bacp.co.uk/events

SHUTTERSTOCK

Making Connections in Birmingham Making Connections is returning to an in-person format from next month, with our first event taking place in Birmingham on Wednesday 4 May. There will be three CPD presentations delivered by expert speakers and an opportunity to network with peers and colleagues. You’ll also have

the option to deliver a two-minute platform and hear from staff and divisional volunteers who will be on hand to answer any questions you may have. We really look forward to welcoming you back to this in-person event, which is free for all members to attend. To book, see www.bacp.co.uk/events

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This online event aims to broaden your knowledge of what it means to transition in the workplace as a transgender or nonbinary individual. This event is for therapists, counsellors, mental health workplace support staff and psychotherapists who’d like to learn more about workplace setting considerations when working with this client group. We’ve invited three speakers to share their experiences, knowledge and perspectives. Topics explored will include use of language, experiences of being misgendered, assumptions around gender stereotypes and heteronormative assumptions in the workplace, including the dynamics of power and control. Jack Jackson (he/him) will share his experience of transitioning with a new employer and the challenges of working as a therapist while transitioning. Karen Pollock (they/them) will discuss how workplace counsellors can reflect on their own practice, assumptions and prejudice in order to see the person and be fully present in the therapy room. Joanne Lockwood (she/her), a transgender awareness specialist, will talk about creating awareness, best practice and allyship within organisations. Focus will be given to co-creating a space for sharing vulnerability as counsellors and acknowledging any fears we may have in being good enough to work well in this area. The event is taking place on Wednesday 25 May from 9.30am–1pm, and costs £35 for members and £75 for non-members. You’ll be able to send questions for the presenters during a live Q&A and join a delegate chatroom to network with your peers. A CPD certificate will also be available. For more information and to book, see www.bacp.co.uk/events

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‘Our members are a trained workforce ready to help provide a solution to a complex problem’

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Earlier this year, members were invited to a parliamentary debate as part of the Build Back Better campaign, a roundtable discussion on investing in post-pandemic mental health provision. The event was hosted by BACP in conjunction with Mind in London and the distinguished panel included key voices supporting the call for improved access to mental health support. Promoting paid work opportunities for members has been one of BACP’s key campaigns for several years, but what was significant about this event was that Government ministers were present on the panel. It was an opportunity for BACP to outline how its members meet the criteria to provide the necessary mental health support and emphasise why BACP counsellors and psychotherapists should not be overlooked when these important decisions are made. Those who watched the live discussion would have hopefully gained insight into some of the arguments that BACP usually puts forward on behalf of members during similar roundtable discussions and other events – that our members are a trained and skilled workforce, ready to help provide a solution to a complex problem. If you haven’t watched the event, it is still available on the website. It might be an eye-opener to hear from others in the sector about some of the common challenges in securing funding, which may not be as straightforward as perhaps thought. The discussion also sheds light on what BACP often encounters while aiming to promote our workforce.

Another BACP focus linked to paid employment is the campaign to have a counsellor in every secondary school and further education college. Our campaign efforts contributed to the success of securing counselling in schools in Scotland in 2019, and we continue to push to see a counsellor in every school in England. In November 2021, MPs debated the provision of school-based counselling in England, and BACP was instrumental in supporting them with relevant data and information. As a counsellor and psychotherapist working in both further and higher education, I have first-hand experience of the burden of long waiting lists and the limited resources to meet that need. I am also seeing decision makers adopting the model of offering six sessions and that

Natalie Bailey

Chair, BACP Board of Governors

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this is fast becoming the norm across schools, colleges and universities. While brief therapy and single-session models have their place, we also know that the six-session model is not applicable in all settings. I wonder if there are some counsellors who are faced with an ethical dilemma if they feel that six or even 12 sessions are inadequate? Are they also facing ethical risks if they are being stretched to accommodate huge waiting lists as counselling becomes more popular, and if they are being made to compromise due to limited school budgets? These issues of compromise may not feature as much in private practice, although there are instances where a client may have fewer sessions than they need because it is all they can afford. Access to therapy, waiting lists and the stigma of accessing therapy in some communities have long been challenges for our profession. What I have noticed changing since I joined the BACP Board as a Trustee is our increased engagement with members to underline some of the work that we have been doing to address these issues. Policy makers are also engaging with us much more. It’s important for members to know about all the campaigns we are involved in, where there have been improvements, and how member subscriptions are being put to use towards achieving our charitable objectives. Our campaign work doesn’t stop, and this is only made possible by the dedicated teams of volunteers and staff working within BACP. ■

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Reactions

Email your views on Therapy Today articles to therapytoday@thinkpublishing.co.uk *Views expressed here are views of contributors, not

Your feedback on Therapy Today articles

necessarily those of BACP or Therapy Today’s editorial team

Full disclosure

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Catherine Jackson’s article, ‘Full disclosure’ (‘The big issue’, Therapy Today, February 2022), came along at precisely the right time for me as a recently qualified therapist setting up in private practice. There was a lot to reflect on in this article, not least my own experience LETTER of therapists in the media, from doing my homework OF THE MONTH in the late 70s listening to Anna Raeburn and Phillip Hodson on Capital Radio (showing my age here) to the present plethora of therapists allowing cameras into their therapy rooms. However, it was the discussion of how social media and public presence relate to practice that really made me think. As an ex-actor and agent in an actors’ co-operative, I am acutely aware of the power of the headshot and felt comfortable choosing the photos I had taken and recording a short video for an online directory. However, the article really hit home in provoking me to think about how I want to be seen in terms of what I write. My integrative training, my supervisors and my client work have developed my inner supervisor, so I am extremely rigorous with any disclosure I feel I want to bring into the room with clients. Why then was I disclosing some personal information about myself and my family on my website that I have never disclosed to clients? In my attempt to seem warm and open, I had been too open. I went back to my website and advertising, subtly changed what I had written but kept some disclosure about my working life. My working life history may put off some people or attract others, and that’s fine. I can’t be all things to all people. As Philippa Perry said, ‘I think it’s good if you put people off when you aren’t the therapist for them.’ Thank you for your highly prescient article. I now feel that I have a better balance in how much I put in what Perry describes as the ‘shop window’ to attract and inform clients about my practice. Nick Rawling MBACP

Working for free The feature on ‘Making concessions’ raised some really valid points for me (‘Talking point’, Therapy Today, February 2022). As a trainee, I felt there was an element of expectation that I would continue with my placement without pay when I qualified. I remember having a discussion with a tutor regarding this and feeling at odds, as my main aim once qualified was to start working to earn back some of the money spent gaining my qualification! Dr Peter Finlay’s comment, ‘Would we consider bargaining with a dentist or vet?’, made me think about other professional services and whether bartering would be

something I would ever do, and the answer is no. I have found it helpful to explore this issue. The issue of fees runs deep with a lot of counsellors, both qualified and trainees. Qualifying and earning decent money has not only increased my confidence, it has allowed me to take time off to take a further qualification, which in the long run will make me a better counsellor. I feel that fees are a very personal choice and those who want to offer pro bono sessions should be free to do so. But my point is, it should not be an expectation for us all. Isn’t it OK to want to earn money from your trade and to charge the fee you feel you deserve? Jo Keenan MBACP, integrative counsellor

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February’s ‘Talking point’ showed the range of views that therapists have on fees, concessions and pro bono work. But there seems to be a small but vocal minority of BACP members who are opposed to unpaid work of any nature. Motion three at the recent AGM, which met the threshold to be considered by the Board of Trustees, would prevent BACP accredited organisational members from offering voluntary placements. All positions would have to be paid a minimum wage. If this motion were to be actioned into policy, it would have a catastrophic impact on charities, on individual counsellors who happily volunteer for them, and on clients’ access to affordable or free counselling. At first glance, it’s difficult to argue against therapists being paid at least minimum wage (and for paid roles, this is of course a legal requirement). It hides a dangerous flip side – such a policy amounts to a ban on volunteering. The charity sector is doing vital, life-saving work. There is no magic money tree, the real-world cost of an anti-volunteering policy would be that some of the most vulnerable in our society would be left without access to therapy. Given that reality, there is something uniquely distasteful about (a few, select) members of a predominantly privileged, white, abled, middle-class, straight and cisgendered profession complaining about being collectively ‘taken advantage of ’ and offering a solution (the end to charity counselling services as we know them) that would then disproportionately impact multi-disadvantaged, black and brown, disabled, working-class, LGBTQ communities. My message to colleagues is simple – if you don’t want to volunteer your time, don’t. But please don’t impinge on my right to do so. Most people in this country cannot afford £50–£70 per session for therapy, and it is a privilege to command that from those who can pay. Name and email address supplied

Depression’s hidden cause I resonated with so many points highlighted by Geraldine Marsh relating to my own diagnosis of hypothyroidism (‘The butterfly in the room’, Therapy Today, February 2022). I was diagnosed with depression and prescribed antidepressants for five years before a locum doctor asked if my thyroid had been checked. After a test, I was prescribed thyroxine, which brought me back to feeling balanced and more ‘human’. Later that year, my son rang me to say he had many of the same symptoms of fatigue and depression. I suggested a thyroid test, the following week he was prescribed 200mcg of thyroxine per day and, 10 years later, he is still feeling well. My mother was prescribed antidepressants for 15 years and, retrospectively, I can see it was probably hypothyroidism. During my eight years working in private practice, I have seen 12 clients on antidepressants for depression that, after a blood test, proved to be hypothyroidism. I also agree with Geraldine that more research is needed around thyroid function in relation to childhood traumas and also genetic transfer possibilities. Linda Taylor MBACP (Accred)

The need for diagnosis I truly empathise with Nicola Townsend and her seven-year search for a counsellor ‘brave enough’ to bring up her son’s autism. As a school counsellor with many years of experience of working with this issue, for me to not ‘bring it up’ would feel like I was failing in my duty of care. Parents contact me desperately searching for help, having discovered the wait for an autism diagnosis on the NHS in our area is more than two years. GPs refer straight to CAMHS so the only choice for diagnosis is either to wait or go down the private route with a psychiatrist at a considerable cost. The presenting symptoms described by parents cover a wide range, but commonly include concerns that their child is not coping

In my experience, an autism diagnosis – whether ‘official’ or self-diagnosed – helps clients feel less isolated and, often, a little bit proud, especially now more high-profile people have been open about their diagnosis

with the demands of school life and that they are anxious, overwhelmed, distressed and not sleeping due to catastrophic thoughts. Common areas of struggle include social interaction, noisy school corridors, eating in front of others, teacher changes and disruption in class. There may also be traits of dyslexia, dyscalculia, dyspraxia and more. On the whole, training workshops for teachers raise an awareness that the neurology of autism means being ‘wired differently’, but generally do not appear to cover how to work with it, so neurodivergent students may still be expected to process and filter information in the same way as the rest of the class. I work holistically with my clients to work out with their school what needs to be done to help them cope – we need the special educational needs co-ordinator (SENCo) on board. With my backed-up evidence of presenting symptoms, I then feel ‘brave enough’ to present to the parent my reasons for thinking their child may be autistic. I trust my instinct about the right time to discuss the dilemma. Nine times out of 10, parents already suspect this outcome; they just want me to validate it. I then give my information sheet of authenticated websites and agencies for various autism tests, enabling the child and parents to take control of their journey of diagnosis. In my experience, a diagnosis – whether ‘official’ or self-diagnosed – helps clients feel less isolated and, often, a little bit proud, especially now more high-profile people have been open about their diagnosis. Ann Holden MBACP, private practitioner

Hope and healing I am a newly qualified counsellor and I was curious to read Linda Gask’s article (‘The healing power of place’, Therapy Today, February 2022) in which this psychiatrist and professor, with so much knowledge, reflects on how she is still working on how to manage her own mental health. She describes her experience of anxiety and depression, of struggling to get through the day, and to ‘do the right thing’. Then later,

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after retiring to her new home on Orkney, experiencing a different type of survival experience – that of being alone and of protecting her house against the wind and rain – during which she also found healing for her emotions and psychological conflicts. I understood that perhaps the new environment allowed an acceptance of the continual process of mood changing, allowing her to be in the experience, while also providing motivation to move forward but without the fixed goals and rushing around of working life. Sometimes I believe that solutions in life come by chance and that there is always hope – as Linda says in the last paragraph, ‘I always thought there would be a future time when I would be able to cope with life.’ Paula Parrondo Coppel MBACP, integrative counsellor

Disability matters Disability often feels like the forgotten ‘protected characteristic’, so as a disabled counsellor, I was really pleased to see ‘You can knock… but you can’t come in’ (‘The big issue’, Therapy Today, March 2022). Whenever I’ve worked with disabled clients, they’ve always valued the fact that, although no two disabled people have the same experience, there is still a sense that I get it. This often fast-tracks the development of the therapeutic relationship, regardless of whether the work has a disability focus or not. Not all disabled people seeking therapy want to work with a disabled counsellor, but if, for whatever reason, you can’t work with a disabled individual, a professional solution is to refer them on. That way you avoid contributing to what a blind friend of mine calls the drip, drip, drip effect of discrimination, highlighted in the article, and/ or the sense of abandonment that is all too often a feature in the lives of disabled people. The disability platform Spokz People has a list of counsellors with disability knowledge and experience (www.spokzpeople.org.uk). Emma West MBACP (Accred)

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To the Editor We very much welcome your views, but please try to keep your letters shorter than 500 words – and we may sometimes need to cut them, to fit in as many as we can

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Obituaries PETER SANDERS

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Peter Sanders, person-centred counsellor, co-founder (with Maggie Taylor-Sanders) of PCCS Books, and author of numerous articles, papers and books on the personcentred approach, including the classic textbook First Steps in Counselling, died on 5 February 2022, aged 70. Here, former colleagues and friends remember him.

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I first met Pete at a conference in 2019. A few weeks later he emailed asking whether I would help him co-write a new edition of First Steps in Counselling. We clearly had much in common, and I soon wished I’d met this kindred spirit earlier – a feeling that is now heavy with poignancy. We shared views on the ongoing importance of the person-centred approach, the troubling politics of the therapy field, and the need for ‘principled and strategic opposition to the medicalisation of distress and all of its apparatus’, as one of his articles is titled. That title had always made me smile – it captured his particular combination of sincere passion, utter seriousness of thought, and provocative mischief. During the rewriting of First Steps with Paula J Williams, while the three of us grappled with the book, ranted about politics and shared the personal challenges of living through the pandemic, we also frequently found ourselves laughing. As I remember him now, it is this shared laughter that stays with me. Andy Rogers, writer, counsellor and supervisor in private practice For me, Pete was a cornerstone of the personcentred approach. For many generations of students, his voice has been key for his clear and accessible articulations of the approach, with sensible advice as to how to practise and develop. Pete was a man of principle and passion, living his life according to his values and beliefs. His radical politics (against any practices resulting in ‘us’ and ‘them’ attitudes) directed his life, moving from counsellor to counselling trainer to book publisher. He often articulated his frustration with the in-fighting within the approach, arguing that we would be better off spending energy creating alliances outside the approach and fighting the obviously oppressive forces in society, like psychiatry. Pete was a hugely valued mentor,

colleague, co-editor, publisher and friend to me. I am hugely grateful for his influence, support and friendship and for his crucial legacy of writing and speaking. Gillian Proctor, lecturer in counselling, University of Leeds Pete was a loving man and a fighter, and someone you could really rely on. He was so sharp and smart, but also compassionate and warm. To set up PCCS Books – what an amazing thing to do: a whole publishing company that could publish books for the person-centred field, and for other areas that Pete cared deeply about, like the abuses of psychiatry and ways of empowering service users. I always looked forward to seeing Pete and the PCCS team at conferences. He’d be there at the PCCS stand, up for a discussion – personal or professional or just joking around. Pete was like a great anchor in our counselling and person-centred world, somewhere safe you could go back to and feel like you could reconnect to someone and to yourself. When I passed on news of Pete’s death on social media, one of the things that people most reflected on was First Steps in Counselling, and how that had, indeed, been their first steps into counselling and the person-centred world. So many people really loved that book, and loved the man who had taken the time to present complex and difficult counselling ideas in a way that was accessible and meaningful to them. But that was Pete – someone deeply, deeply committed to social justice and to creating a world in which everyone has access to all the best things that life can offer. Mick Cooper, professor of counselling psychology, University of Roehampton

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I met Pete at the University of Aston in Birmingham in 1974, where we both did the one-year full-time diploma in counselling in educational settings course. While being a counsellor in his bones, Pete was a regular guy and we did regular guy things together, like going to Sloopys disco, where we did the bump to ‘Pick up the Pieces’ by the Average White Band. While our lives went in different directions, we were always connected, and latterly Pete and I would message one another when either Aston Villa (his team) or Arsenal (my team) were playing. I will miss Pete, but my memories of us together are vivid, and if they ever fade, the opening bars of ‘Pick up the Pieces’ will bring them flooding back. Windy Dryden, emeritus professor of psychotherapeutic studies, Goldsmiths, University of London Pete first came into my life through his published writing, as is the case for so many of us, and latterly on Twitter, where we began to interact regularly. He was so enormously encouraging to me in a way I cannot begin to describe. I am sure he wouldn’t have minded me sharing this small example of the encouragement he gave me – it speaks to so many therapist activists of my generation, and it speaks too of his generosity of spirit. ‘You are so important because you have today running through you. It is difficult if not impossible for me and other people of my generation, who trained in the early to mid 1970s, to properly engage with 2020. We have too much baggage. There are some bits of baggage that have useful messages, but they need to be reinterpreted and reapplied. Over to you, and good luck!’ I know the things he told me will stay with me throughout my career and my life. Goodbye Pete, and thank you for the opportunities and encouragement you gave so many people. Erin Stevens, humanistic, integrative counsellor and psychotherapist ¬ Donations may be made to one of Pete’s favourite charities, the British Heart Foundation, at www.bhf.org.uk/ how-you-can-help/donate/yourdonation/get-started

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DR ELSPETH SCHWENK Dr Elspeth Schwenk, BACP Fellow, member for almost 35 years and former Deputy Chair of the Board of Governors, died in December 2021 aged 66. Initially a member of the BACP Workplace executive, Elspeth was elected to the Board in 2008. She became Deputy Chair in 2012 and stepped down from the Board in late 2015. In the years since then, Elspeth continued her work supporting BACP in several ways, especially in the development of the supervision competence framework. Elspeth was married to Gil for 41 years and had three children: Hans, Stefan and Heidi. A therapist, supervisor, trainer and university external examiner, Elspeth often presented at conferences at home and abroad. She established Wiltshire-based Lifetrek with Gil to support teams and individuals to lead and grow their businesses and to be their best selves. Here, some of Elspeth’s former BACP colleagues pay tribute. Elspeth was a deeply committed and true friend of BACP and an absolute stalwart of the profession. The Board and I would like to express our profound thanks to Elspeth for her remarkable contribution to BACP and to the profession. She will be sorely missed for her skills and expertise, and also for her kindness, generosity of spirit and great sense of humour. Hadyn Williams, BACP CEO When you become a trustee of an organisation that you have been a member of for many years, and then become Chair of that organisation, the associated feelings include fear, trepidation, a sense of being an imposter, and so on. That was my experience when I first joined the Board at BACP, but I really needn’t have worried. One of the very first people I met was Elspeth, who became very quickly one of the key people I could rely on and trust implicitly. Was it her wisdom, for that was extensive? Certainly. Was it her humour, because she was witty and naughty in equal measure? Absolutely. Or was it because, simply, she was one of the kindest, most caring and loyal people I have had the pleasure to

encounter in my working life? Her contribution to the profession of counselling was almost unparalleled; her generosity to others truly meant, and her capacity to guide and counsel was always with a lightness of touch. I felt incredibly sad at news of Elspeth’s passing, that something had shifted in the world and we were worse off for it. I am forever grateful, however, to have spent some time alongside her on our mutual journeys. Andrew Reeves, former BACP Chair Elspeth was Deputy Chair when I joined the Board. She was very much liked and respected for her substantial knowledge and expertise and for her warmth and passion. She had a gift for handling difficult situations with humanity and good humour, and contributed significantly to the work of the Board during the change of CEO and change of Chair. She continued to support BACP’s work after leaving the Board and was a true friend to the Association, to which she gave many hours and boundless energy. Fiona Ballantine Dykes, BACP Deputy Chief Executive Elspeth and I spent many an hour, many a day sitting with our colleagues around the boardroom table, listening, debating and hoping to make good judgments on issues affecting the future of the Association and the profession. Elspeth was an invaluable and supremely reliable member of any committee, any discussion, any working group. I could trust her judgment. She was circumspect, clear, able to take the broader view, and had a sense of fun that could prick the bubble of collective

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self-importance. My last BACP connection with Elspeth was through the supervision competence framework, to which she and I contributed through the expert reference group. As ever, she was lively, funny, self-deprecating and brought a wealth of experience. It’s a cliché to say but she is a loss to the profession. Elspeth gave with kindness, generosity, thoughtfulness and a lightness that almost concealed her knowledge, understanding and wisdom. Thank you, Elspeth – many of us are changed through knowing you. Alan Dunnett, former BACP Board member I had the privilege of serving on the Board of Governors during the time Elspeth was Deputy Chair. I have very fond memories of Elspeth and her warmth, graciousness and dedication. I also have happy memories of her wonderful sense of humour, witty conversation and enthusiasm. She was always generous in sharing her wisdom with others. Elspeth was inspirational in her commitment to the counselling professions, BACP, its members and their clients. Deeply saddened by her loss, I’m also very grateful for the learning and time she so willingly shared. Caryl Sibbett, former BACP Deputy Chair As a colleague on the Board, Elspeth had a clear commitment to the counselling profession and a particular interest in supervision. I remember her being diminutive in stature, but not in personality. She would have a twinkle in her eye as she delivered a killer one-liner. She was good at being funny and at being warm and at being contrary. From our conversations, it was clear how much she loved her family and how proud she was of all her children. I think that’s what I remember most of all – her love of hearth and home. That was a huge part of her, and I think that’s what brought her most joy. Mhairi Thurston, former BACP Board member ¬ Gifts of condolence can be given to Dorothy House Hospice Care, which supported Elspeth and the family. Donations can be made at www.justgiving.com/fundraising/ elspeth-schwenk

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‘Once we have awareness we can choose to do something different’

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I was talking recently with an organisation I provide professional support to about equality, diversity and inclusion (EDI) within the workplace. What struck us was that the one common thread on every single job description within this varied organisation was a sentence about EDI. However, none of the staff are ever questioned about EDI performance during their annual appraisal. It’s got me thinking – how can we move from a position of tick-box, mandatory training (that many don’t engage with) and automated assumptions to actual engagement, a desire to increase awareness because we want to rather than because we have to? Maybe this is about moving from a place of treating everyone as the same to treating everyone as different, unique and wanting to understand their place of difference, rather than pretend it isn’t there. I see this as both an individual and an organisational task. Language too is a key area. Consciously inserting more inclusive language is such a small thing really but it can make an enormous difference to those actively included. For example, using ‘people’ rather than ‘men and women’ actively includes those outside the gender or sex binary; asking clients which pronouns they use moves us away from making assumptions based on presentation, or using ‘partner’ rather than ‘husband’ or ‘wife’, which includes those who are gender diverse and those in same-sex and non-monogamous partnerships. Far from eroding the category of ‘woman’ or ‘wife’, supporting equality for all genders, sexualities and relationships adds weight to equality for women. Then what about membership bodies such as BACP and UKCP? How can and should they make EDI training mandatory and accountable? How do they/we balance freedom of speech with a profession of expected non-discrimination? As registered BACP members, we have an obligation to complete regular CPD and keep

a record of our annual training expectations and outcomes. I have added an element to mine so that EDI awareness is there as part of my ongoing CPD arrangements. I don’t lose sight of it this way. Each time I’m at the planning stage, I ask myself which area I feel I need more awareness in. While I need to keep up to date on gender, sexual and relationship diversity (one of my areas of expertise), I also need to make sure that my knowledge around race, disability, class or sex work, for example, doesn’t get left behind. I can’t know everything about everything, but I invite myself to become better informed each year and therefore a better ally to those who are disadvantaged in different ways from me, both professionally and personally. I actively want to know more and to understand more about the areas

Luan Baines-Ball (they/them) Therapy Today Editorial Advisory Board

Luan Baines-Ball is a BACP senior accredited psychotherapist and senior accredited supervisor working in private practice. They have particular interests in working with difference and diversity and the impact of early separation on adult relationships. www.bainesballcp.co.uk

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where I have an advantage – those areas I don’t have to think about every day. I have noticed that it can feel challenging and exposing to grapple with the idea that we have advantage over another. As therapists, this can feel very uncomfortable, and we can get defensive when questioned or invited to expand our thinking. I think it is important to separate the ‘I wasn’t aware of that’ from ‘I am a bad person’. Once we have awareness we can choose to do something different. Similarly, once we have awareness about a relationship or behaviour that isn’t helpful for us, we can choose to respond differently. Once we have awareness that our inner critic is having a field day we can learn to be kinder to ourselves and others. Many therapists come from a place of early wounding, hence the phrase ‘wounded healer’. I wonder if we can learn to respond to EDI and inherent advantage/disadvantage from a place of determined interest rather than a place of fear? Fear seems to be at the heart of many discussions: fear of difference, fear of the unknown, fear of harm and fear of erasure. I understand it can be difficult to get something wrong. Getting it wrong is OK and most trans people, for example, will tolerate being misgendered as long as the other person corrects themself. If we are unaware we have made a mistake, the trans person will have to do the correcting so they are not erased – something they sadly will have experienced all too many times before. When people in privileged positions get it wrong, they can often feel uncomfortable and then project that back onto the oppressed person. I’m aware that the same sensitivity of getting it wrong can be there regarding race, disability and class too. So it’s really important that we all step up to the plate and look at our own places of privilege and oppression, and ultimately improve our understanding of those in oppressed places.

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From the Editorial Board, 1

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Mental health and the human experience in the arts, media and online Documentary REPRO OP

Essay

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In this fascinating essay, Cambridge University neuroscientist Camilla Nord highlights a currently topical theme: interoception – or how we feel what we feel inside our bodies. Interoception explains the interaction between body and brain and why it is that when we feel low in mood, we are likely to feel physical pain more painfully, and when we have an inflammation in our body (like a viral infection), we feel depressed. Nord proposes that, if we can identify the part of the brain linked specifically with interoception, we can also find ways to manipulate it, and thereby treat mental health problems. And her research suggests it’s the mid-insula. This teensy bit of the brain is structured to be able to communicate with both the more emotion-related anterior insula and the more body-sensing-related posterior insula; it is also responsive to mindfulness and breathing exercises. It’s exciting when neuroscience finally catches up with what counsellors and psychologists have been working with intuitively for years. Available on the Psyche website at bit.ly/356peID

The Puppet Master: hunting the ultimate conman is a three-part documentary series that has been described as ‘horrifying but gripping’. It tells the almost unbelievable story of how a conman, Robert Hendy-Freegard, convinced a young agricultural student Sarah Smith and her boyfriend that he was an MI5 agent and that, if they didn’t come on the run with him, their lives would be in danger from the IRA. What’s most shocking is that they lived as fugitives, not contacting their loved ones, for 10 years, and handed over thousands of pounds from Sarah’s trust fund. Yet Hendy-Freegard served only two years in prison, and is since suspected of controlling another woman, whose children appeal for her to get in touch. The series explores the nature of coercive control with expert input from BACP member Linda Dubrow-Marshall and her psychologist husband Professor Rod DubrowMarshall (check out Linda’s ‘Analyse me’ column on page 74). Available now on Netflix. Theatre

The Patient Gloria

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Every counsellor knows about Gloria – the hapless, divorced young mother persuaded by psychotherapist Dr Everett Shostrum to be filmed in separate therapy sessions with Carl Rogers, Albert Ellis and Fritz Perls. The aim was to contrast the three masters demonstrating their respective arts – person-centred counselling, rational emotive behaviour therapy and Gestalt. Intended originally as an educational film, it ended up playing in cinemas all over America, betraying Gloria’s privacy. This award-winning play, part of this year’s Brighton Festival, is described as a ‘ballsy meditation on therapy, misogyny and female desire’. It will, no doubt, be a sell-out, given how many therapists live and work in the city, so book now for performances at the Theatre Royal Brighton from 11–14 May. bit.ly/3hdHjak

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Interoception

The Month, 1 Know of an event that would interest Therapy Today readers? Email therapytoday@thinkpublishing.co.uk

Exhibition

Drama

THE EASTON FOUNDATION/DACS, LONDON AND VAGA AT ARTISTS RIGHTS SOCIETY (ARS), NEW YORK. PHOTO: MARK BLOWER/© THE HAYWARD GALLERY

With anxiety-inducing events playing out on the world stage, make time for something soothing and heart-warming, like this super-sweet new comedy drama. As We See It features 20-somethings Jack, Harrison and Violet, who share a flat and also autism diagnoses (as do the actors who play them). We follow them as they navigate the challenges of work, relationships and daily life in a world that expects them to be ‘normal’, interspersed with group support sessions deftly managed by their in-house carer, aspiring medical student Mandy. It is based on an Israeli series, On the Spectrum. The first episode starts with a remarkable portrayal of the sensory onslaught that, for some autistic people, is the experience of simply walking down the street. Season one is available now from Amazon Prime Video.

THE WOVEN CHILD Described by Time Out magazine as ‘like Hellraiser’s haberdashery’, this is a must-see for fans of Louise Bourgeois’s dark and visceral representations of childhood and womanhood. Loomed over by one of her giant spiders (apparently, for Bourgeois, the spider represents the ‘repairer’), the show is the fruit of the final 20 years of her long career, when she turned to fabric and textiles, inspired in part by her own childhood – her parents were tapestry repairers. ‘Surreal’ and ‘violent’ frequently feature in the reviews, along with ‘harrowing’, but there is also a theme of healing and fixing. Like Paula Rego, Bourgeois was insistent on giving life forms to what few of us want to find in our unconscious. At London’s Hayward Gallery until 15 May. bit.ly/3potjPm

As We See It

Podcast picks

Relationships explored • Alonement is a podcast about the positive side of spending time alone and finding joy and value in solitude. Each week, journalist Francesca Specter asks a guest about how they spend time by themselves. Don’t miss straight-talking NHS clinical psychologist Dr Emma Hepburn on the myth of ‘happyland’. www.alonement.com/ podcast

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• Elizabeth Day, host of the long-running and award-winning series How to Fail, has often referred to the wisdom of her ‘best friend’ in her podcasts. In this episode, she finally reveals her bestie to be BACP accredited therapist Emma Reed Turrell, author of Please Yourself. The pair discuss Emma’s self-help guide for people-pleasers. On most podcast platforms.

• In The Sexual Wellness Sessions, therapist Kate Moyle explores sex and relationships with the help of experts, including Dominic Davies, founder of Pink Therapy, on unpacking sexual diversity, and Bryony Cole, the world’s leading authority on ‘sextech’, on the future of sex. Available on most podcast platforms.

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Riding the waves Catherine Jackson reviews the impact of the pandemic mental health tsunami

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f anyone doubted the estimate first published by the Centre for Mental Health back in October 2020 that, post-pandemic, some 20% of the UK population (10 million) would need new or additional mental health support, the statistics now emerging seem to be playing out the gloomy forecast. The latest Government data update states that the number of people contacting the NHS seeking help for mental health problems is at a record high, ‘in the context of underfunded mental health services facing a care backlog, waiting lists and a stretched, exhausted and understaffed workforce, which will likely make services harder to access’.1 The Centre for Mental Health itself reviewed its estimate in May 2021, and concluded that its original forecast was correct:2 ‘Key groups of people who face an especially high risk of poor mental health include people who have survived severe COVID-19 illness (especially those treated in intensive care), those working in health and care services during the pandemic, people economically impacted by the pandemic and those who have been bereaved.’ And another major concern is that the figure of 10 million includes 1.5 million children and young people. According to a recent Government research summary,3 the more vulnerable children and young people have experienced worsening mental health throughout the pandemic, particularly during the lockdowns, although ‘most remained mentally well’. The impact is due largely to the effects of social isolation and

school closures, the research says. The impact is highly variable, with different surveys finding conflicting results on the relative incidence of depression and anxiety, PTSD and behavioural issues. However, what is incontrovertible is that the overall rate of mental disorder rose from one in nine pre-pandemic to one in six in 2020, and referrals to child mental health services reached record highs in May 2021. From April 2020 to March 2021, there was a 37% increase in child mental health service referrals, and a 59% increase in referrals for child eating disorder issues over the previous year, reflecting greater demand, rather than a knock-on effect of families delaying help-seeking during the pandemic, the statistical summary states.

In the counselling room

In June last year, BACP released the findings of its own ‘Mindometer’ survey of the impact of COVID-19 as reported by a sample of 5,000 members.4 This revealed a highly varied and complex pattern of presentations in counselling. Anxiety (87%), stress/feeling overwhelmed (82%) and loneliness/social isolation (72%) were the top three most commonly presented problems, and members also reported people who are seeking

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help for mental health issues for the first time in their lives. Almost half (46%) of members said incidences of trauma increased; a quarter (26%) reported an increase in eating disorders; two-thirds (65%) saw an increase in relationship pressures and breakdowns; 26% in obsessive compulsive disorder and 20% in addiction, addictive behaviours to substances or substance misuse, while seven per cent reported an increase in addiction to the internet, and five per cent an increase in gaming addiction. Nearly three-quarters (71%) reported a rise in demand for their help and 47% an increase in clients asking for more sessions. In terms of issues discussed in counselling, the most common at 81.7% was anxiety, followed by stress (81.5%), loneliness/social isolation (71.8%), depression (68.1%), relationship pressures and/or breakdowns (64.7%), social anxiety (64.3%), feeling lost or hopeless (60.5%), bereavement and grief (58.6%), family issues (56.5%), trauma (45.6%), pressures of combining work and home schooling (43.8%), and issues linked to domestic violence/abuse (28.1%). Therapists also reported increases in people from minority communities seeking support, as well as an increase in those presenting with racial trauma in the context of COVID-19, the death of George Floyd and the Black Lives Matter movement. Others listed mothers feeling overwhelmed due to the combination of pressures and demands from being a parent, working, home schooling and their usual support network not being as readily available. There were also reports of more young people and men seeking therapy, possibly due to reduced social

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The Government’s COVID-19 mental health and wellbeing recovery action plan5 talks of a focus on prevention and early intervention, but for many of the people going to their GP or seeking counselling, CBT self-help exercises and psychological ‘first aid’ may not be enough. Certainly this is the view of BACP, which in February hosted a roundtable discussion in central London with the Minister for Mental Health, Gillian Keegan, Shadow Mental Health Minister Rosena Chantelle Allin-Khan, and Sir Norman Lamb, former Liberal Democrat MP and Minister for Mental Health in the Coalition Government, to discuss how we as a nation are going to meet the needs emerging in the post-pandemic era.6 BACP Chair Natalie Bailey told the assembled experts and BACP members: ‘It’s affected young people, older people, people working in the NHS and education, blue-light services and people affected by bereavement, poverty and debt. Counselling and psychotherapy are part of the solution to a major issue. They’re critical to the recovery from the pandemic. More funding for counselling will help tackle some of the deep-rooted inequalities. Investment ensures appropriate, culturally sensitive and accessible choice before the problem escalates.’ In its recovery action plan,5 the Government acknowledges that, while many people will regain their usual sense of mental wellbeing once the threat of the pandemic recedes, some people’s mental health has taken a harder, longerlasting hit during the pandemic: ‘Groups who had the highest risk of mental illhealth before COVID-19, including those living with pre-existing conditions, seem to have been worst affected. The mental health impacts of the pandemic have also been felt keenly by those directly affected by the virus – people who have been bereaved, people who have survived an acute illness, people living with long COVID, and our amazing frontline and key workers.’

‘We’d like to see an enhancement of the role of counselling and psychotherapy within the NHS workforce’ The plan sets out a range of oneoff and specific investments aimed at boosting the overwhelmed mental health system, including bringing forward further roll-out of mental health teams in schools by a year, and putting more money into IAPT to boost its capacity to meet escalating need – £38 million to enable an additional 380,000 people to be seen. IAPT is also named as the main point of treatment for people with psychological problems due to long COVID. But the strategy does not deliver what BACP has been pressing for – more employment within the NHS for qualified counsellors and psychotherapists to increase access to talking therapies at primary care level. So, while Mental Health Minister Gillian Keegan used the roundtable event to point to the £110 million going into expanding adult mental health services, including talking and psychological therapies, and another £111 million to increase the workforce to deliver services and train more staff, this didn’t answer Hadyn Williams’ point: ‘Why create new roles when we already have a highly skilled, trained and available workforce? Workforce expansion is cited as one of the biggest barriers to delivering the expansion of mental health services as set out in the NHS long-term plan. The NHS often overlooks the highly qualified, experienced, skilled counselling and psychotherapy practitioners who already exist and don’t need to be trained up. We’d like to see an enhancement of the role of counselling and psychotherapy within the NHS, which better uses our trained workforce. IAPT has a significant role to play but isn’t the only solution.’ Back in September 2020, the BMA released a report highlighting what

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it predicted would be the long-term impact of COVID-19 on mental health services. Its prescient forecast highlighted precisely those areas where the Government now records the highest need:7 social isolation, people with long-term mental health problems, people on low and no incomes, black and minority ethnic communities, and NHS and other frontline workers. For those most immediately impacted, ‘a strong public health response is required to address concerns about an increase in certain mental health conditions, such as depression, anxiety, substance abuse, post-traumatic stress disorder and complex grief,’ the BMA said. But its call for parity of spending with physical health, which BACP has also been seeking in relation to psychological therapies, has still not been answered.

Children and young people Amid the panicked media headlines about the rising incidence of severe mental health problems in children and young people post-COVID and the focus on growing waiting lists for specialist CAMHS services, it can seem – oddly – as if the children and young people around which all this is flying are forgotten. There’s an apparent (and unfounded) faith that getting to the holy grail of a CAMHS appointment will cure the whole problem. Meantime, little is done to treat the debilitating symptoms along the child’s journey. Numerous surveys have highlighted that children and young people are more anxious, more hopeless, more eating disordered and more likely to feel suicidal and to self-harm because of COVID, but given that the experience of the pandemic can’t be cured, how do we help them live in the here and now and regain their resilience to pick up their journey into adulthood? Ben Nuss is a school counsellor based in Denbighshire, north Wales, where he covers two large secondary schools. He says what he has primarily noticed in the young people in his schools since they returned post-lockdown is a sense of all-pervading anxiety. ‘The presenting and predominant issues aren’t necessarily

different, they are just magnified – more complicated, more severe, a higher level of risk in terms of self-harm, suicide ideation and adverse childhood experiences. COVID took away the coping mechanisms – sports clubs, afterschool clubs, hobbies, interests – a lot disappeared and haven’t been replaced, or the young people just haven’t gone back to them,’ he says. Sonia Winifred is both a counsellor and a councillor – she works for a charity providing individual counselling to children and young people in primary and secondary schools across south London, and is also the cabinet member for equalities and culture in Lambeth Council. Among children and young people in the 11–17 age group especially, she has observed a new apathy: ‘There’s a lack of enthusiasm, of interest in anything or anyone. School is a chore, they don’t want to go there, they say the lessons are irrelevant and boring, the teachers are inadequate, and when I ask where this is coming from, they tell me it’s since lockdown.’ She says the young people seem to have lost sight of who they are and what they once enjoyed, and lost their sense of agency: ‘They feel they have lost control. So much was taken away from them by the pandemic. But my worry is that this isn’t just one or two, it’s collectively all the young people I work with, telling me the same thing.’ She’s also noticed a new problem with eating habits in young men in particular, which in turn is affecting their sense of self and self-esteem: ‘Some have been bingeing out of boredom and put on weight, some are excessively exercising. They feel they are just not good enough. There’s a loss of a positive sense of self, of who they are and how they look. I find it alarming and disturbing. They are also angry, very angry – at themselves and at the world.’ Niki Gibbs, a former school counsellor who now works as a supervisor to school counsellors and pastoral staff in secondary schools, says the Government needs to invest now in a greater school counselling presence in every school. ‘A year ago I was already seeing problems emerging as pupils returned

to school – impeded social development, disconnection from friends, worsened family relationships, anxiety generated by the loss of predictability and security, a rise in extreme feelings of hopelessness and helplessness, an increased exhibition of distress through eating disorders and self-harming behaviours – these are all still being experienced by our young people. ‘There’s a chronic lack of timely access to therapeutic services that means these problems are now becoming entrenched in our young people’s psyches – which I believe early intervention via therapeutic help could have avoided. There is a large pool, a sea even, of distressed young people who have not only experienced deterioration in their mental health during the pandemic but who are now still suffering and still deteriorating, as they are denied the support they need to recover and heal. This is undoubtedly a crisis in the making.’ Gibbs is co-chair of BACP’s schoolbased counselling expert reference group, which has been playing an active role in taking forward the ongoing campaign for a counsellor in every school in England, as is the case in the other three UK nations. ‘Having a school counsellor in every school would mean that pupils could access therapeutic care at the point of need, early on in their distress, to avert the deleterious effects we are seeing on our young people’s mental health,’ she believes.

Inequalities Agrani (she wished to remain anonymous) is a trainee therapist and a Hindu, and describes vividly how families and whole communities have been devastated by COVID, not just in terms of deaths (and Asian communities were particularly

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hard hit, along with African and African Caribbean people) but in the impacts of multiple bereavements. ‘What I see in my community is collective trauma. There has been no way to process the grief individually and it has affected the wider population too,’ she says. ‘When someone dies, there is normally a period of 13 days of mourning, when every person for whom the deceased was significant comes to visit the immediate family to pay their respects and share their stories and memories. It’s an incredibly precious thing and not to have it is heartbreaking for the family but also for those who would normally have offered that support – we’ve lost that opportunity to show those people we really care about them. It means families are left with their feelings of loss without the support of the community around them.’ And this was happening repeatedly, and often concurrently, throughout the height of the pandemic. ‘I attended a dozen funerals online and it was really challenging because you can’t show your feelings or show your support. I had a real sense of dissociation,’ she says. ‘Those wounds are hard to heal.’ Her little boy has lived through repeated periods of mourning, sometimes overlapping. ‘What effect will that have?’ she asks. ‘It was too young and too soon for us to be having those kinds of conversations with him.’ She finds it hard to be around people who haven’t been touched in this way. ‘For some people, their experience of COVID is that it slowed down their life and gave them more time and space to be with their families. It’s been a time of growth for them – luxurious, even. And I find it massively triggering to hear that.’ In her role as councillor, Sonia Winifred is once again able to get out and knock on doors, finding out how people in her community are coping postpandemic. What she is seeing in Lambeth is, she says, a massive and growing accumulation of stress among the least advantaged – financial and housing pressures on top of coping with all the losses of the pandemic. Moreover, many bereaved families have had to bear the costs of several funerals. ‘They came to the council asking for help,’ she says.

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‘As counsellors, we try to help people find meaning so they can carry on, recognise what they are going through and find that strength within themselves to go forward and survive and manage the guilt that they could have done more when in fact they weren’t allowed to, so they don’t pile it onto themselves. Listening to people on the TV and radio – yes, people feel a sense of injustice, but others I think just want to be left alone to grieve because they haven’t been able to. They want to be able to think about their loss and have time and that quiet space to grieve. They are just coming out of this and some will come out sooner than others, but so many have lost so much, they need time now to quietly and respectfully deal with that loss. And facilitating that is part of our role too.’

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School-based counsellors like Ben Nuss are aware that they are only reaching the tip of a much larger iceberg. ‘I have a lot of sympathy for the pastoral staff in schools; they are incredibly oversubscribed,’ he says. ‘The pastoral staff are under constant bombardment. Whatever pops up, they have to respond there and then. They are on the frontline, more than I am as a counsellor, and I don’t think they get the support and clinical supervision they should.’ But, he says, ‘In the same breath, I have been astonished and incredibly impressed by young people’s ability to rise above this – yes, it’s hard and the deck does seem to be stacked against them, but it’s not a situation beyond hope. You do still see these resilient young people finding ways to rise above it.’ Trainee counsellor Diane Pummell works in a large primary school in Twickenham, and has been looking for ways to rekindle and nurture the children’s resilience and support them to readjust and regain a sense of safety now they are back in the classroom. With the head teacher’s blessing, she set up a club called Wellbeing Warriors – a lunchtime drop-in club, open to anybody in years four to six. ‘I was also aware that there’s never enough of me to go round. I see this as an early intervention – a quiet, safe,

‘As counsellors, we try to help people find meaning and strength within themselves to go forward’ creative space where children can chat and things may come up that I can pick up early on,’ she says. ‘We discuss topics like self-care and feelings, and a peer support culture is beginning to emerge; they are making new friendships and several children are finding their voice by talking about worries or sharing their experiences in a safe space.’ In Birmingham, Citizen Coaching, a counselling service and social enterprise run by former BACP Board member Martin Hogg, has launched a specialist new service, Citizen Navigator, to signpost clients to non-counselling resources, to help meet local needs for support. The project is funded by a £50,000 grant from social investor Key Fund. The Citizen Navigator programme is building relationships with charities, social enterprises, statutory and voluntary groups so Hogg and his colleagues can refer people on for advice on housing, debt and other such day-to-day practical issues. ‘We came up with the idea of Citizen Navigator after we noticed people who came to us for counselling had so many fundamental problems going on in life, it got in the way of the counselling,’ Hogg says. ‘GPs don’t have the time or capacity to signpost patients to other support services, so they come straight to us. We want them to empower themselves for the future to take some of the resources we give them, so they can be more self-sufficient when they need help.’

REFERENCES 1. UK Parliament. Mental health impacts of the COVID-19 pandemic on adults. Postnote 648, July 2021. bit.ly/3JHZyAO 2. Centre for Mental Health. COVID-19 and the nation’s mental health: May 2021. London: CMH; 2021. bit.ly/3p99nQb 3. UK Parliament. Children’s mental health and the COVID-19 pandemic. Postnote 653, September 2021. bit.ly/36sh2CM 4. BACP. BACP Mindometer report 2021. Lutterworth: BACP; 2021. bit.ly/3Ic2YLL 5. HM Government. COVID-19 mental health and wellbeing recovery action plan. 27 March 2021. bit.ly/3sfVuBR 6. BACP. We call on Minister to deliver critical investment in therapy [Online report]. 2 February 2022. bit.ly/3JNGWPS 7. BMA. The impact of COVID-19 on mental health in England: Supporting services to go beyond parity of esteem. London: BMA; 2020.

Future planning

According to the Centre for Mental Health’s 2021 report,2 the predicted levels of demand for mental health services are two to three times that of current NHS capacity, and this will continue for up to five years. ‘This is

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not a scenario where services can grow incrementally to meet steadily rising levels of need. Instead, Government and the NHS must take action now to meet a very steep increase in demand for mental health support,’ it says. For BACP CEO Hadyn Williams the solution comes down to Government investment at a primary care level to deploy an available counselling workforce: ‘We’d like to see much greater investment to ensure fully funded and appropriate counselling and psychotherapy which use the capacity of our trained workforce, across all settings including schools and colleges, across our NHS and through community settings.’ Counselling has much to offer, both individually and at a public health level through early intervention in our most vulnerable communities. The aftermath of COVID-19 is, essentially, a collective problem affecting us all, but mostly affecting those who have least to lose.

About the author Catherine Jackson is a freelance journalist specialising in counselling and mental health.

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year ago today I had absolutely no idea I’d be writing an article like this. I had a lovely, balanced life. I still have a lovely life, but a radically different one. It all changed in that one moment when I was told that I had cancer. I was absolutely devastated, and stunned beyond belief. I asked myself, how could this be? Why me? What did I do wrong? I hadn’t been ill. I looked and felt well. I had a huge sense of disbelief. In that one moment it felt like my future had come to an emergency stop; my hopes and dreams were completely shattered. My life changed more in a split second than I could ever have imagined. After a short while, my pragmatic self kicked in and I was overwhelmed with a sense of urgency to get on with treatment. I knew that my ‘plumbing’ would be different, but I thought I’d soon be back to normal and have my lovely life back. How wrong I was! Little did I know what was ahead and how completely different my life would be. Every aspect of it would be affected. My treatment plan involved a course of chemotherapy, followed by major reconstructive surgery. I received a lot of information about the physical effects of my plan but I was totally unprepared for the emotional trauma of having cancer treatment in order to save my life. After my treatment finished, I didn’t feel the same person as I had before the diagnosis: my self-confidence had withered. Gradually the support – professional, and from family and friends – reduced and I felt panic and apprehension that I was facing this next part alone. I cried a lot, I became easily distressed and I was extremely frustrated at being in this lonely place. I contacted the local Macmillan team, who were and continue to be absolutely incredible. They referred me to a counsellor, who completely got me. The counsellor explained that being diagnosed with any serious illness is a massive shock to the body and mind, as we are reminded of our mortality. I felt so reassured to hear this as it validated all my feelings in one go. She also explained that we can exhibit childlike behaviour at times like this, when our security is threatened. That was music to my ears – I was indeed behaving like a toddler. I wanted and needed regular praise, reassurance and attention. In my early years I would hide from difficult situations, but here there was nowhere to hide.

I realised through my counselling sessions that I was grieving and that I needed to allow myself the time to do this. I tried to tell myself to show self-compassion and that I was doing my best. As my counsellor described it, my train had been derailed. I have had to learn to stop assuming that my life would get back to normal, because my normal has changed and I have changed. My priorities have changed. I have had to learn to recognise and acknowledge my vulnerability. I have worked on my new identity so I know who I am now and not who I was. I have realised I have experienced many losses and that I need to allow myself time to grieve. I’ve lost body parts, body functions, self-esteem, financial stability and security, to name but a few. My physical needs have changed; they are almost unrecognisable to what they were. My personal care involves constant management of bodily functions with catheters, bladder washouts and needing always to know where the nearest toilet is. This is relentless. I was and still am determined not to be a victim and not to be determined by the cancer. This might sound easy but it is far from that. I feel like I’m riding on a wave. Some days it was and still is all too much and I have to dig very deeply for the tools to stay afloat in the choppy waters. I often feel hurt, angry, bitter and resentful when I reflect on the events of the past few months, but these days are getting less. I found it hard describing to myself my relationship with cancer. I’m not a survivor (yet!) and, equally, I’m not a sufferer now, so I describe myself as a cancer experient. I know there is no such word but it feels right to me. The future is uncertain, as it is for all of us. I saw a post on Facebook describing cancer as like having a gun held to your head and that’s exactly how it feels. I am learning to live with the uncertainty yet not to live my life in fear. The road to recovery, both mental and physical, is long but I am progressing slowly. I know I will find my new destination or I will meander along where the train takes me. I believe trying to understand myself and then others is hugely important. Looking after myself continues to be essential. Counselling has helped me remain grateful for everything I have in my life, and it’s given me the courage to face the rest of my life, whatever it holds, with integrity.

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About the author Amanda Phipps is a mother, businesswoman and an NHS employee. She has started writing about her journey with cancer to raise awareness and encourage others to seek support at the earliest opportunity.

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Catherine Jackson: You’ve published a book on grief, and another about how people cope with major transformations in their lives – why did you choose family as the focus of your third book, Every Family Has a Story? Julia Samuel: In 30 years, there has never

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When people come to therapy, they bring their family with them Julia Samuel talks to Catherine Jackson about why families matter

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been a client through my door who hasn’t talked about their family, whether it’s their family of origin or the family they have now. I wasn’t trained as a systemic therapist – I don’t think I was even aware it existed when I was training – but I do think families are the bedrock of our lives. We need our team. We need our people beside us. We are innately social animals. We need our ‘tribe’. Families really matter. Some of us make our family from our friends and the people we care about, if our family of origin can’t provide that close network of strong, loving relationships. Of course, when ‘family’ goes wrong, the suffering is immense. I think therapists are understanding more and more the importance of context. Thirty years ago, therapy was about the individual and their relationship with the therapist. Now we understand much more how systems of inequality, racial prejudice, all the cultural, financial and societal contexts have a huge impact on our mental health and ability to deal with adversity. When people come to therapy, they bring their family with them – metaphorically but also physically in the case of the people I describe in the book. The Anna Freud Centre now has a family school where the caregivers come to the school with the child, so they can learn from observing the therapist and teachers. Then, when their child comes home, the caregivers have the coping mechanisms to manage their behaviours. They find the children have better outcomes if the family is involved in this way.

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CJ: But, as you say, families are also the place where the deepest and most lasting harm can be done. You write very honestly about your own family – your parents, grandparents and also you as a parent. And you also write very powerfully about compassion, curiosity and encouragement to explore families of origin, and that is what you hope to offer readers from reading this book. I’ll quote it, because you say it much better than I can: ‘Learning about other people’s families has helped me process my relationship with my own – those stacked behind and ahead of me. I see my grandparents and parents with more compassion. It hasn’t removed my sense of responsibility when I think of the errors I made with my own children, but perhaps it has softened my guilt. It has meant I have had important conversations, and learnt surprising truths, good and bad. Despite significant unknowns that have emerged, I stand on firmer ground and feel more confident as to who I am. Which is strangely paradoxical. The exploration and openness matter just as much as the results.’ JS: Yes, I made lots of mistakes as a parent and as a child. I have to be responsible for the mis-steps I made and the hurts and things I got wrong. I have to recognise that we are all flawed and not attack and blame myself for them. Writing the book changed my relationship with my parents. I became much less judgmental. I could really get it that they were holding a lot of trauma. But they did not have a clue – they wouldn’t even have known the word in the context we apply it today. And they did the best they could. By the time she was 25, my mother had been bereaved of her father, mother, sister and brother, and my dad, too, his father and brother both died when he was still very young. And yet they never talked about them. There were these black-and-white photographs all around the house, and I knew their names but nothing about them. It wasn’t just them, of course; it was that whole generation. The attitude was very much that what you don’t think about isn’t going to hurt you. But for me, what I didn’t hear and didn’t see gave me a curiosity to know more.

Intergenerational trauma CJ: I thought also that what you write about intergenerational trauma is very clear, and how you explain what is often not fully understood about how psychic harm can be passed down the generations. JS: I think there are two routes. One is

behavioural – when there is a trauma in one generation and the pain isn’t dealt with, that avoidance is then passed down to the next generation and the next until someone is prepared to feel the pain. Often the coping mechanisms that people develop do them and subsequent generations much greater harm than the trauma itself. So much of addiction is about trauma that isn’t processed and is used to anaesthetise the pain. Then there is the research into epigenetics and the work of people like Rachel Yehuda, about epigenetics and levels of cortisol in the womb and how our threat system is wired in utero if our mother is subjected to or has unprocessed trauma.

CJ: How do you work with that as a therapist? JS: I use EMDR as an evidence-based

treatment for trauma. But also, our brains have huge neuroplasticity. We are wired to adapt and change. It is the rigidity of our resistance to change that is the block. We have the capacity to deal with these inherited difficulties. The first step is obviously awareness, and that is what I hope for with this new book. Many clients walk through the door feeling incredibly anxious and thinking there is something wrong with them. What I want is for people to look up and out across the multiple generations, to look at their mum and dad, their grandparents – what did

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they experience that they never voiced? I want people to understand this isn’t all about them – it doesn’t necessarily start with you. I want people not to self-attack but to be curious about how it happened that they are where they are.

CJ: Are we all haplessly doomed to have our ways of relating laid down in the womb and our early years by our experience of being parented? How come a person like Archie in your book can be born of and raised by a mother who clearly had unprocessed trauma and would probably be labelled with narcissistic personality disorder, and yet transform himself into a very rounded and emotionally resilient partner and father. How do they do that? JS: There is a whole part that is genetic.

At birth, we have a genetic blueprint for personality, IQ and athleticism, which gives us a propensity that is then developed or diminished depending on the environment we are born into and grow up in. Some people are born with a greater capacity to overcome adversities. And then again, we have this benefit of neuroplasticity. Archie had a mother with narcissistic personality disorder, and he learned and repeated her behaviours as he grew up into adulthood, but he wanted to change, and he had a very good therapist, so he was able to replace his mother’s template with that of his therapist. People have this spellbinding curative capacity to change the lens through which they see themselves and the world, and to operate in the world differently. That doesn’t mean they are over the difficulty that they had. Archie never got over that his mum wasn’t the mum he would have chosen. People often think that therapy enables people to get over whatever is wrong in their life or how they are in the world. Therapy can’t fix the past but it can give you the capacity to deal with the past so you don’t act it out in your own life and on other people, so you can live a very fulfilling life despite your very difficult past.

CJ: Another downside of the family that you explore is that it can be quite a restrictive institution. The family gets put before the individual. I was fascinated by the ultra-Orthodox Jewish family, the Berger women, in your book – their family coherence and solidarity rested entirely on avoidance – ‘looking away’

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from sensitive and upsetting topics. There’s an unspoken sidestepping so as not to rock the family boat, so that each generation of women follows the same well-trodden path laid down by their Jewish faith. You write warmly of them, but is it the case that the family can be both nurturing and protective, but the price is individual freedom to choose your own ways? JS: The Berger family spanned Kati, who

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survived the Holocaust and Auschwitz, her daughter Anna, her daughter Rebecca, her daughter Dina and little Leah, just a few months old. I think their history had taught the Berger family that safety and being together was more than compensation for the loss of individual choice and freedom, and the fact that they could make that choice. They were a happy family. From the outside, I found it inspiring. I could see the power and inner strength of it, but imagining myself in it, I would be completely suffocated by the rigid rules and obligations of their faith and the way they lived. From their perspective, it was clear to me that they were wondering, without being at all condescending, ‘Why wouldn’t you want this?’

CJ: You also, in other chapters, discuss the pain of letting go of the next generation and being able to allow the children to find their own selves. How does the family allow its next generation to find their own way without destroying ‘the family’ – its traditions, values and so forth? Is there a recipe for that? JS: That very much links to This Too Shall Pass, my second book – we as parents of children who have grown into adulthood need to allow ourselves to feel the pain of that transition as

they leave home and move away. As a parent, I wanted my children to grow up and go off and find their own partners and create their own families, but at the same time I found it excruciatingly painful that I was no longer the centre of their worlds. They had a new centre, which was their partner and children. But I was part of that world too. As a parent to adult children, I don’t think I should impose my beliefs, assumptions and ways of being on them. You hope your children have your core values, but how they live them and what they do with those values has to be their choice – certainly for most Western people.

CJ: At the end of this latest book, you offer 12 ‘touchstones’ for the wellbeing of the family. Might you add, ‘Be true to your feelings’ to your 12 touchstones? Or, ‘Be honest’? Is honesty and speaking truth always the best policy? JS: It’s true that you can only have trust if you

have honesty, but I think often people can be overly honest. Sometimes it’s better not to spew out everything you have in your head. Whether you are a teenager or an adult, we have to recognise that, when we use words as weapons, they stay stuck in the other person’s body for the rest of their lives. You have to be honest generally about how you feel, but finding a way to manage your emotions to allow you to frame them and express them in the service of the relationship makes an enormous difference to how they are received.

Public persona CJ: Moving away from the book itself, a recent ‘Big issue’ article in Therapy Today explored the questions and tensions raised when therapists have a significant personal public, media and social media presence, and whether this damages the therapeutic relationship. I’d be interested in your views on this, as someone who is consistently in the public eye. Does your public profile enter the therapy room, and how do you manage the dynamics if a client raises it? Do you disclose much in or outside the therapy room? JS: It’s a really complicated and important issue that we as professionals need to explore and have a much greater understanding of. It’s an issue I take to supervision a lot. I don’t have any easy answers. In terms of my public profile,

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I have had some clients who stopped coming because they found it difficult and confusing seeing me interacting with other people in media interviews or when they’ve watched me interviewing someone on Instagram Live. I am, as a rule, very boundaried about what I disclose – I disclose almost nothing about my home and private life, partly because I don’t want to, partly because I work best with clear boundaries and they’ve supported me in my relationship with clients, and partly to safeguard that precious space for my clients. But I am sure clients can read my personal reactions in my face. I think most clients are able to pick up the depth of your understanding in how you react to what they tell you and the language you use. But I need to have a public profile to sell my books, and I want to sell my books because I believe they have valuable content that can help people, so I can square that ethically – I am using the media to expand my learning from the counselling room out into the world. But there is a grey area around being a therapist and having a public presence that I haven’t fully sorted yet. Maybe it is always going to be a bit messy.

CJ: Do you think some clients come with certain expectations of you because of your public profile? JS: That’s definitely true, but I think that is true of every client coming to any therapist – the hope that this person is going to do something magical for them. It might be more intensified because they’ve read an interview, heard a podcast or read my books. We work with the distance between their projections and the reality of being in the room or on Zoom with me. You work with what they bring, name it, own it and don’t hide it.

‘I need to have a public profile to sell my books, and I want to sell my books because I believe they can help people’

CJ: It’s generally agreed, we have moved from an era of repression of public expression of emotion to what some might call ‘oversharing’. Do you see this greater willingness to share personal pain and tragedies in public as a good thing in terms of our mental health? JS: I think the growing awareness and

understanding of the harm of putting on a brave front and the benefits for mental health of being able to voice personal distress are really important. But there is a tremendous risk in what I term ‘promiscuous honesty’. I think what drives the trend is the hope that, by putting yourself out there on social media or in media interviews, you will be understood and heard and valued for what you bring. But it can make your suffering worse when you don’t get the response you hope for, or – worse – are subject to trolling and attack. That kind of response strikes at the very core of our identity. We are genetically programmed to need to be loved in all our different aspects, if only to stand out to attract a mate, but social media has a toxic interface with those innate human tendencies. You want to stand out and be loved and noticed, so you say very extreme things or expose yourself in very vulnerable ways, and that can have the reverse effect. It brings attack. I think there needs to be a whole new rule book about managing yourself online. When people talk to me in therapy, I want them to be honest, to feel safe enough to show all of their vulnerability and their issues to me.

Influences and icons CJ: Which counselling theorist has most influenced you? JS: Like many therapists, I’m not fixed on

one modality – I draw on a lot of different techniques and practices. But at my core I am person-centred. Carl Rogers is my man. I remember reading On Becoming a Person about half a dozen times in my first few years of training, and how it really spoke to me – being seen as you are, with all your faults, and that we all have the potential to change; it’s innate within us and it will emerge, given the right therapeutic relationship.

CJ: What in particular did you learn in your training that you think was valuable to you in your work with clients? JS: That innate drive to self-actualise in

Rogerian theory and also, I think, the power

of groups. The groupwork in the course really changed me. I think group therapy is more powerful in many ways than individual therapy. The theory is that the power of your experiences is multiplied by the number of people in the room, and I had really positive experiences of those groups – and also difficult ones, of course, but I look back on those days with an enormous amount of gratitude.

CJ: Who for you has been the most influential living person in the therapy world? JS: Penny Daintry, who was one of my tutors

at Metanoia. I remember looking at her and thinking, ‘I want to be able to do what you are doing. I want to have a bit of you.’ The way she held herself, the way she communicated, the way she held us all and could describe what was going on. She went on to be my supervisor for many years, and that mentoring and helping me believe in myself were absolutely fundamental to my being a therapist. The way she supported me and didn’t shame me when I made mistakes and allowed me to grow and have confidence in myself – it makes me cry even now just to think about it; it was absolutely transformative for me. I think her having confidence in me allowed me to have confidence in myself – and we all need someone like that in our lives.

CJ: You say in your new book, everyone needs a go-to person, and especially in childhood. I wondered when I read that, who was your childhood go-to person? JS: My parents’ dogs – my parents always had

If I really feel someone minds about me, that helps me mind about myself and take care of myself, and vice versa. We have to learn these skills in order to work as therapists, but I think at the centre of the therapeutic relationship is heart, and the love we have for ourselves and our clients. I just wish I could find a less twee way of saying it.

CJ: Heart works for me! Thank you, Julia, for your time and honesty.

About Julia Julia Samuel MBE, MBACP (Accred) is a Vice President of BACP. She has been a psychotherapist for more than 30 years and is the author of three bestselling books. Her latest, Every Family Has a Story (Penguin), is out now.

dogs, all through my childhood. They were never in a bad mood, always pleased to see me, and very comforting. They let me cuddle and stroke them and they were very reliable and consistent.

CJ: And if you could choose any therapist from all the living practitioners in the world to be your therapist? JS: I’d really like to be a client of Stephen

Grosz, the author of The Examined Life. He has a sensitivity, pace, grace, curiosity and particular presence that I think would be incredibly curative and powerful.

CJ: What’s the most valuable lesson you have learned from your work with clients? JS: For me it’s about being in a relationship

of non-possessive love. It’s the best medicine.

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About the interviewer Catherine Jackson is a freelance journalist specialising in counselling and mental health.

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With the best will in the world

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All practitioners have an ethical duty to create a clinical will – Michael Toller explores the detail of making and maintaining a clinical will that is fit for purpose

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magine a client coming to a session to find that their therapist isn’t there. No one answers the door. They have a phone number and email address they can use to contact their therapist, but there is no reply. A few days later, they still haven’t heard from their therapist. The client is in the dark and unsure about whether to come back for their next session, or even whether the therapy will continue. What the client doesn’t know is that their therapist was taken ill suddenly and won’t be able to contact their clients until they recover. This really happens, and worse; therapists, like all people, sometimes die unexpectedly. In cases like these, clients can be left unsupported and likely worried or distressed about what might have happened to their therapist. Often, the only person who knows where to find a comprehensive list of client contact details is the practitioner themselves. As part of our duty of care towards our clients, we have to consider what will happen in the event that we are suddenly unable to carry on working with them. For many clients, an unexpected or unexplained ending in the therapeutic process might be disturbing or damaging. For these reasons, making a clinical will is explicitly mandated in the ethical frameworks of all major professional membership bodies, such as BACP, UKCP and the British Psychoanalytic Council (BPC), as well as recommended by many training organisations. Clearly, clinical wills are a fundamental part of working ethically. BACP members are required to ‘consider breaks and endings in respect of our death or illness of sufficient severity to prevent us communicating directly with our clients’.1 Specifically, the Ethical Framework requires members to have appointed someone to communicate with clients and ‘support them in making alternative arrangements where this is

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desired’. It also states: ‘The person undertaking this work will be bound by the confidentiality agreed between the practitioner and client, and will usually be a trusted colleague, a specially appointed trustee or a supervisor’ (Good Practice, point 42).2

What is a clinical will?

At its simplest, a clinical will is a set of instructions made by a therapist, counsellor or coach for what will happen to their practice in the event that they are no longer able to work due to sudden illness or death. As a minimum, it lays out how clients can be contacted and supported if a practitioner is unable to do so themselves. Importantly, the requirement is not only to make sure clients are notified if their therapist or counsellor is taken ill or dies, but that any contact is made by an appropriate person and takes place within the limits of clinical confidentiality. This person – usually known as a clinical trustee – might also help clients think about finding a new therapist, or offer to support them in coming to terms with an unplanned end to their therapy. Therefore, the person we appoint to contact our clients on our behalf is usually another practitioner we trust, or someone else with the clinical experience and qualifications to contact our clients in a supportive and sensitive way. A separate function of a clinical will is to reduce the administrative and emotional burden on family or friends if we fall ill or die, especially as they may be anxious or grieving, or preoccupied with other duties relating to our illness or death. In the same way that we take our ethical responsibilities seriously as practitioners, we should also consider how to minimise the impact of our illness or death on those closest to us. A clinical will helps do this. I started to think seriously about what is involved in setting up a clinical will a few years

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ago when I joined BPC, as its members are required to demonstrate they have a clinical will by registering the name and details of their clinical trustees. As I began to think about creating my own clinical will and the circumstances in which it would be used, I soon realised it presented several practical challenges. To be truly fit for purpose, a clinical will needs to be updated every time a client leaves or joins your practice. Listing your clients’ details on paper means they can be quickly out of date and, depending on where the list is kept, might be hard for your clinical trustee to access in a hurry. Some practitioners I spoke to told me they used a passwordprotected Word document that they emailed to their clinical trustee – again, this requires remembering to update and resend it to your trustee regularly. Security is also an issue. Many practitioners now use password-protected practice management software to manage their practices, but you can’t simply give your clinical trustee the log-in details. Under UK data protection law, such as the General Data Protection Regulation and the Data Protection Act 2018, we are required to make sure we only share information for a good reason (called ‘legitimate interest’), and giving a trustee access to records that include process notes or other information not related to the function of a clinical will would breach these regulations.3 Last, I was aware that, if I suddenly fell ill or died, my wife would be expected to inform my clinical trustee and facilitate them accessing my client records – something I wanted to make as easy as possible for her in what would likely be difficult circumstances. Given the way technology has increasingly made it easier to manage our practices in many ways, I started thinking seriously about whether a digital platform could provide a solution to

session days or times, and any other relevant information that will help them contact your clients supportively and sensitively. For example, you might want to indicate that illness or death is a trigger for a client, or give details of what you want your clinical trustee to tell your clients about what has happened. You might also want to include details of how a client prefers to be contacted – for example, by email rather than by phone. Other details to consider include: ■ contact details for past clients, especially if you keep materials they have a right to access after you have finished working together (for example, materials produced in art therapy) ■ the names and contact details of your supervisees, if relevant ■ instructions for the disposal or deletion of physical or digital client records. These might include details of where to find paper records, or how to log on to devices or accounts that hold digital records containing confidential client information.

the clinical will conundrum: a means to store the relevant client and business details securely, but in a way that made them both easy for me to update regularly and easily accessed by my clinical trustees if needed. Inspired by the challenge I faced, I have spent the past two years helping to develop a web-based platform, ClinicalWill.app, designed to help therapists and counsellors more easily set up and maintain a clinical will that is up to the job. As part of the project, I spoke with dozens of practitioners and used their feedback to improve the platform, based on their needs as practitioners. Along the way, I learned a lot about clinical wills, as follows.

Getting started

If you work as a practitioner in an organisational setting, there may be a formal procedure in place, should you fall ill or die. However, if you work in private practice you will need to take responsibility for your own clinical will.

This may also apply if you work for a smaller organisation. If you are unsure, it is your responsibility to check, as it is unlikely anyone else will do so on your behalf. The following practical points will help you set up a clinical will that is fit for purpose. As a starting point, decide what information to include. At a minimum, a clinical will should contain: ■ the names and contact details of your current clients ■ the names and contact details of your clinical trustee(s) (see below for more information on selecting who to act as clinical trustee) ■ the names and contact details of your next of kin or clinical will ‘initiator’ (see below for more information on selecting your next of kin or ‘initiator’). You may also want to include other clinical information about your clients that your clinical trustee might need, such as details of

‘As well as the information in your clinical will, you need to consider who will make sure your instructions are carried out, and how’ THERAPY TODAY

Beyond this information, you might also include non-clinical details related to your practice, such as: ■ details of any other people or organisations you work with – for example, peer supervision or professional development groups, EAPs or insurance companies you work for, any relevant professional membership bodies, and your own therapist ■ details of accounts held with other relevant businesses, such as the landlord or manager of your consulting room, your professional insurance provider, website hosting companies, and any therapy directories or social media platforms associated with your practice.

Next of kin and trustees

As well as the information your clinical will contains, you need to consider who will make sure your instructions are carried out, and how. Planning this will be your responsibility, so you should make sure you ask someone who knows you personally to act as your next of kin or clinical will ‘initiator’. They will be responsible for contacting your clinical trustee if you fall ill or die suddenly and will likely be a family member, friend or neighbour you know well. You might want to ask more than one person to act as your next of kin or ‘initiator’, as this will make it more likely that your clinical trustee is contacted quickly, if needed.

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Best practice

Best Practice, 2

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You also need to ask someone appropriate to act as your clinical trustee. They will be responsible for carrying out the instructions in your clinical will. As outlined above, a clinical trustee needs to be someone with the relevant clinical qualifications and experience to act on your behalf within the limits of client confidentiality. Therefore, clinical trustees are usually other practitioners, such as a colleague or supervisor, most likely working in the same modality or therapeutic approach as you. Sometimes, clinical trustees agree to act for each other in a mutual ‘co-trustee’ arrangement. Again, you might want to ask more than one person to act as your clinical trustee, as this will make it more likely that your instructions are carried out as intended. Some membership bodies, such as BPC, formally require you to nominate two clinical trustees. It’s important to discuss with your clinical trustee and next of kin what is expected of them and leave them clear instructions about what to do if they need to carry out their responsibilities as agreed with you. You might want to consider including details of whether your clinical trustee is expected to deal with outstanding fees, or fees paid in advance, on your behalf. Consider carefully where you will leave any information your clinical trustee needs to access. You will need to make sure any clinical or other sensitive information, such as passwords for accounts or devices, is stored securely but is easily accessible by your clinical trustee if they need to carry out your instructions. This might involve leaving a physical copy of the relevant information in a safe place they can access, or giving your clinical trustee access to a secure digital copy of the relevant records. Ideally, all the information they need will be easy to locate in one place. Once your clinical will is complete, you need to inform your clients about your arrangements by adding the information to your contract and verbally updating existing clients. This is required under data protection regulations, but it also forms part of our ethical obligation to be transparent with our clients about what would happen in the event of us unexpectedly falling

ill or dying, and to discuss this with them if they have any questions. Finally, you might want to inform the executor of your personal will about your clinical will, and make sure your personal will allows for any instructions you give your clinical trustee, such as permitting access to any relevant documents or personal devices containing client or business details. If you want your clinical trustee to be reimbursed for their time in administering your clinical will, you will need to include instructions in your personal will for how this will be done, and also how any repayments of outstanding or overpaid session fees should be managed.

Keeping it up to date

Once you have set up your clinical will and chosen your clinical trustees and next of kin or ‘initiator’, it is important that you make sure the arrangements you have put in place remain fit for purpose as long as you are working. In particular, this means you must keep your clinical will up to date. Most importantly, this means adding or removing client contact details as soon as possible. Forgetting to do this might mean that your clinical trustee does not contact a client you have taken on recently or mistakenly contacts a client you have already finished working with. You will also need to regularly review your agreements with your next of kin or initiator and clinical trustees, inform them of any important changes to your instructions and ask them to tell you if they decide they can’t carry out their responsibilities any longer. While it is possible to set up a functional clinical will using more traditional approaches, such as a safely stored physical record or a password-protected digital document that is sent to your trustee by email, I have found that a single, secure digital record, as provided by ClinicalWill.app, helps me to maintain a clinical will that meets the above requirements with very little difficulty. In order to make the platform as accessible as possible to other practitioners, ClinicalWill.app is now available for general use on a ‘pay what you think is fair’ basis, although

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we suggest users pay an annual subscription equivalent to a single client session fee to maintain the platform’s financial viability.

Self-care

Whichever approach you decide to use, it’s worth reflecting on whether you also want to act as a clinical trustee for other therapists and if so, for how many. Although it is very unlikely, in cases where you need to carry out your responsibilities as clinical trustee to more than one practitioner at a time, you may struggle to do so adequately. Don’t underestimate the amount of work it might take to fully carry out a colleague’s instructions in the way they have requested, and the impact their death may have on you. Finally, it is important to remember that creating your clinical will involves considering circumstances in which you might fall ill or die. As Roslyn Byfield points out,4 you might find doing this isn’t easy, whether in relation to yourself or in imagining the likely impact on family, friends, clients and colleagues. As well as the practical planning involved, you might want help in working through the wider implications of what it means to face the possibility of your own death or illness. If you feel you need more support, you could speak to your supervisor or personal therapist about this. REFERENCES 1. BACP. Clinical wills and digital legacies in the counselling professions. GPiA 104. Lutterworth: BACP; 2020. 2. BACP. Ethical framework for the counselling professions. Lutterworth: BACP; 2018. 3. ICO. Data sharing: a code of practice. Wilmslow: Information Commissioner’s Letter; 2021. bit.ly/3rDuM5M 4. Byfield R. Why clinical wills matter. Therapy Today 2016: 27(8).

About the author Michael Toller works in private practice as a psychodynamic counsellor and professional coach, and is part of the team that created ClinicalWill.app, the world’s first end-to-end encrypted clinical will management system for counselling, therapy and coaching practitioners.

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JOURNEY INTO THE UNKNOWN

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Anthea Kilminster describes a culturally sensitive, trauma-informed approach to working with displaced people

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Lally* came for help feeling depressed and fearful. She was dealing with severe panic attacks that could be triggered at any time and were linked to the trauma of female genital mutilation (FGM). Flashbacks of the procedure led to severe hyper-arousal compounded by fears that her daughter might have to experience the same. As part of a team at Solace (Yorkshire and Humber), I aim to deliver a specialist, culturally sensitive therapeutic care approach for people like Lally and other refugees and asylum seekers. The aim is to help clients stabilise, process trauma and develop their capacity for reparation and resilience. With this article, I hope to offer insight into the challenges we face in providing a culturally responsive approach, and how we address the

barriers experienced by these groups to accessing help with their mental health. Throughout, I have shared anonymised client experiences, shown in italics. Worldwide, there are an estimated 70 million1 internationally displaced people, or ‘international citizens’,2 comparable with the total population of the UK. This group comprises asylum seekers (people applying for protection from persecution under the UN Convention and awaiting a decision from the Home Office) and refugees (people given permission to stay in the UK following a successful claim under the UN Convention or through resettlement programmes such as the Afghan Relocations and Assistance Policy, or the Vulnerable Persons Resettlement Scheme). There are myriad reasons for these groups being in the UK, such as escaping from persecution or state

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violence, fear of death, human rights abuses such as FGM, or through human trafficking or modern slavery. Solace is the only agency in the Yorkshire and Humber region dedicated to providing individual and group psychotherapy, including specialist pain, trauma and sleep disorder therapies, to refugees and asylum seekers. Among our practitioners are therapists who specialise in EMDR, hypnotherapy, CBT and rewind trauma processing. We have a child and family wellbeing unit specialising in psychotherapy for families arriving on United Nations High Commissioner for Refugees (UNHCR) resettlement schemes. Originally set up in 2006, we are funded from the statutory sector by local authorities and the NHS. We are also now receiving a Home Office grant to develop

a model of mental health support to be rolled out throughout the UK, including e-learning and training for other professionals. On average, we get between 160 and 200 new enquiries over a six-month period. At the time of writing, we are providing support for around 300 people – 157 adults and 51 households, from countries such as Syria, Kuwait, Iran, Sudan, Eritrea, Albania and Iraq. Common experiences are pre-migration trauma – trauma from dangerous and protracted journeys to the UK – and post-migration trauma – stress from being in a new country while dealing with multiple losses and complicated systems – all contributing in some cases to complex trauma and/or post-traumatic stress disorder (PTSD).

collectivist cultures and those with a stronger family interdependence.3 My aim, however, is always to draw on theories with applicability to universal human experiences: for example, those grounded in neurological evidence of the encoding of traumatic experience. I also assume that, while psychoanalysts’ empirical work was largely based on European people, they have brought insight into very early psychic processes in the development of self in relation to others and the management of lifeseeking or destructive internal processes. For example, Kleinian ideas of separation between self and other and emergent ambivalent feelings towards others that transcend splitting still underpin my understanding of human development.

Drawing on theory

Tasmah*, who experienced forced marriage at 14 and a life of pleasing her in-laws, insisted on me leading the sessions. I also noticed other ways in which she was happy to be led by others. To remain culturally sensitive, I held any Western feminist ideals in check in order to remain open to where the work would lead us. Seeking sanctuary in the UK had separated her from her beloved daughter and this experience began to lead the therapeutic process. I seemed to represent a ‘caring’ figure or object in her mind – characteristics she associated with her daughter – and she gained comfort from having her daughter alive in the therapy space. In her silences, though, I wondered if I could also be a figure for more hostile angry feelings through my powerlessness to be able to reunite her with her daughter. The course of therapy helped to contain love, mourning, anger and emergent guilt about having left her daughter.

I am one of a team of 25 paid and volunteer qualified therapists employed to provide a systemic, multi-modal approach to meeting client need. We tailor a therapy package around their individual situation, initially to stabilise them and then to help them begin to process their experiences. My background is in a relational dynamic approach that draws on theories and tools from an eclectic range of sources, including personcentred counselling, intersubjectivity, psychoanalysis and neuroscience. I am also trained and have an interest in working with trauma and in energybased approaches such as emotional freedom technique (EFT). I was drawn to joining Solace because of my interest in the neurological and somatic effects of trauma and how this might be addressed through psychotherapy. I approach a culturally sensitive psychotherapy session as a journey into the unknown – a rich, unexplored territory. I wonder how my white, Western, cultural perspective may have parallels with a client’s life but may also have shaped me in a different way. Relational psychoanalytic approaches have challenged Western Eurocentric ideals of human development – for example, it asks that attachment theory should take into account different child-rearing practices in

‘I approach a culturally sensitive psychotherapy session as a journey into the unknown – a rich, unexplored territory’ THERAPY TODAY

The therapeutic alliance There is compelling evidence that a strong therapeutic bond is the basis of all therapeutic work and that it is the quality of the relationship, not the modality, that has the potential to impact on outcomes.4 Humans are created in relation to and through the care of others who we need for survival when young. We know that connection breeds emotional health and isolation breeds despair.5 Abu* mourned family who had not come with him to the UK. The abrasive manner in his interactions with me reflected broken trust towards authorities who had given him the impression that his family could easily follow. After many weeks and an emergent bond between us, he described the scene of his home after bombings and the destruction of a working farm that had taken 30 years to build. I found in my memory a loss of my own, albeit on a much smaller scale, and something in me opened up to him. Sharing this story seemed to help him to find some peace through this connection with me. A relational dynamic model outlined by Macaskie et al4 provides an essential foundation or way of working. Within this, I have found it helps to integrate and understand how transferences and countertransferences may be influenced by perceptions of cultural differences or unconscious biases. I would recommend the work of Layla Saad6 for a full examination of using self and identity in what can be conceptualised as a white therapeutic space and an essential need to understand the racial stereotypes that shape our perceptions of others. Cultural conflicts between therapist and client may block other aspects of relational conflict unless examined.3 Relational theories work with social location and racial positioning as part of the transference. We must also take on board issues of social context following immigration, such as a tendency to regress to earlier developmental stages in a new country and the effect of interpersonal losses and subsequent changes in identity.3 I always raise my possible place in the client’s mind as an object of white UK

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authority or potential persecutory figure. This was dramatically highlighted once by a client’s dream where she thought I was working for the Home Office and would be deporting her. Exploration of her fears was crucial to establishing a feeling of safety in the therapeutic relationship.

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On my first encounter with Tatti*, I was struck by her colourful hijab and T-shirt, contrasting sharply with her black trousers and outer garments. Later, I learned much about her early life in a polygynous community. The colours came to represent her shifting moods – life and death, laughter and silences, darkness and light. I felt the alliance we built reflected an ease she had developed by being with many other women. Using the symbolism of colour also enabled me to open up discussions of our different skin colours and whether my whiteness might represent a separate object and a barrier to her sharing her story when she seemed to withdraw into her own thoughts.

Safe trauma practice

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There is some agreement between psychoanalytic and neuroscience theories about the processes at play at the point of trauma: that the protective mechanisms prevent the internal world being overwhelmed by external forces during traumatic experience. This in turn affects normal memory processing and, in the long term, leads to flashbacks and feelings of being back at the time of trauma.7 Trauma-focused approaches that can be integrated within a relational dynamic model such as EFT can supplement and alleviate bodily distress. EFT has a cross-cultural efficacy, and when clients resist it, it seems more on an individual rather than a cultural basis. It comprises kinaesthetic tapping techniques, using the fingertips, on meridian points of the body, to keep emotional energy moving, and may work like acupuncture in traditional Chinese medicine. Trauma is neurologically encoded, and EFT is a way of decoding emotions from neurological pathways through a process known as de-potentiation. As this is also calming, it acts as a stabiliser or anchor as part of phase one safe trauma practice.

‘A complex web of shame often compounds and prevents discussion of emotional difficulties in many cultures’ Gyor* presented with extreme bodily agitation at the first session. It seemed impossible for him to keep still, which made it hard for him to adjust to a slower rhythm in therapy, and particularly with the time delay from using an interpreter. The agitation seemed to delay the development of trust and a psychological bond. The trauma in his body from the torture he had experienced seemed visible in his discomfort. Normalising what he was experiencing through discussing how fear, as a normal response, sometimes becomes stuck from the time of the trauma, went some way to helping convince him he wasn’t internally falling apart. Using EFT to work with visual body language cues such as holding his fists up to his neck – symbolic of fear and self-protection – seemed to enable him to move and process the emotions that were part of the agitation.

Respecting spirituality Spiritual beliefs can represent lifeaffirming or destructive influences on people. Belief can be a protective factor against suicidal intent and give hope and peace. It can also be a controlling force ensuring compliance, such as in the belief that juju would kill someone speaking of her experience of FGM. It is important to work respectfully with spirituality and the following example highlights how working with the idea of part-selves can be useful when a client is struggling with fearful or persecutory ways of thinking. Manu* had been in two traumatic road accidents and EFT with psycho-education had not been effective in processing hypervigilant feelings that found form as spirits when he was alone in the house. Eventually he revealed a historic encounter with a clairvoyant who predicted his death and that of his wife. This, together with his belief in qareen or jinn spirits that follow you, seemed at the root of the hypervigilance. Manu was in two minds about the prophecy and the presence of qareen, and we worked on developing dialogue between the part-self that wanted to question the truth of the prophecy and the part that feared its truth.

Working with stigma A complex web of shame often compounds and prevents discussion of emotional difficulties in many cultures. This can be aggravated further by human rights abuses that involve torture or sexual assault and may trigger family dishonour. Trauma manifests in physical symptoms, which are often felt as a more legitimate way of seeking help, usually from a doctor. A psychotherapeutic response to this needs an understanding of how to work cautiously with shame, not giving too much air too soon; upholding therapeutic boundaries of time and place but with a flexible approach to cancelled sessions due to physical illnesses, and use of non-stigmatising language, such as ‘flourishing, in balance, at peace, tranquil,

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feeling shut down, having hope, inner strength, survivor, opportunity’, checked with interpreters for cultural veracity.

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The role of interpreters Language could present an insurmountable barrier to accessing therapy without trusted and competent interpreters through which the therapy flows. While this can slow the process down somewhat, it is important for the client to be able to use his or her language, which can facilitate access to emotions. In some cases, speaking English may be chosen for the session, and may illustrate a need to identify with the white, host culture and may induce feelings of greater power. It may also give distance from emotions and this can ensure safe trauma processing. All these factors need to be considered and assessed while also following client preference.

My first two sessions with Kauba*, conducted in English, were largely un-noteworthy. However, in the third session, with the use of a telephone interpreter, it was as if an emotional floodgate had burst. His body went into hyper-arousal as he talked in his own language about his journey to the UK. Grounding techniques were needed to calm his limbic system and meet him back within the window of tolerance. I have found it important to work with client transferences to interpreters in the same way as any other transference. For example, I have noticed familial transferences towards a male interpreter from a bereaved client who had lost many brothers. It is also important to consider that each participant brings former experience of triad relationships. At different times each member may play a role in the drama triangle of victim, perpetrator and/or rescuer.8 Client dreams that involve interpreters can be used as material in sessions and the symbolism of the interpreter’s presence can be explored productively. It is crucial that, as clinicians, we maintain responsibility for the therapeutic process, and I would recommend Costa’s protocol.9 Working with race and culture, interpreters can be crucial cultural navigators and debriefing sessions can reveal useful cultural information. For example, I needed to be told that a client’s fears about a hysterectomy went beyond the loss of her fertility/aspect of her womanhood and might mean her husband would leave her for a wife who could conceive.

Liminal space As Brech2 notes, when seeking asylum, international citizens occupy a temporal or liminal space, with life on hold. Thinking together about this can often be at the forefront of the work examining extreme anxiety, frustration, anger, fear and the need for internal reparation and resilience to cope in this period. There is some evidence that resilience cannot be taught but can be nurtured by helping clients to consolidate strengths that have helped them to navigate difficulties in the past.10

Clients can be helped to unblock natural reparation capacities that may have become blocked, by giving space for all associated emotions to emerge.7 I have found it helps clients reconnect with the person they believe they used to be, reflecting back a sense of power and strength that they have temporarily forgotten they once had.

link people of all groups in a community. Clients can be signposted to agencies dealing with destitution or legal help with asylum claims or for help with housing, health and education. Following the social prescribing model, clients may also benefit from being referred to community activities geared to their particular interests and skills. ■

Shema* felt she was being ’morally killed‘ by her situation – thrown away. She was losing weight and completely frustrated by any attempts to continue with her life and her dreams of pursuing an education and a profession. She had been waiting for four years to hear of a positive decision about her asylum claim. It became important to keep alive the part of her that dreamed of this life, which meant keeping alive her beloved grandmother in her mind, who had treasured her and wanted this for her.

* Clients’ names and identifying details have been changed.

Social capital Working towards internal reparation can be helped by encouraging external resources that have cultural meaning, which can be an important factor in beginning to move on. The latter sits well with the current focus on social prescribing1 in the NHS and important work in communities creating inclusive space that takes account of culture: for example, fear of the outdoors, which can often feel like a ‘white space’. Another way of thinking about this is the concept of social capital, which is linked to the benefits people accrue from their social networks (adapted from the work of Bourdieu and cultural capital).11 When social capital in communities is developed and networks are strong, health seems to correlate positively.5 The health benefits of social capital are reflected in the extent to which social networks provide cognitive and emotional help as a buffer against the stresses of life. It is within and from social networks that social capital can be obtained and used to promote mental health and wellbeing, thereby increasing resilience.12 As refugees begin to put down roots in a community, they can be helped to connect to bridging social capital – networks that

THERAPY TODAY

About the author Anthea Kilminster MBACP (Accred) is a psychotherapist working for Solace: Surviving Exile and Persecution, an organisation that provides mental health and wellbeing support for refugees and asylum seekers in Yorkshire and Humber region.

REFERENCES

1. Watters C. Mental health and wellbeing: intercultural perspectives. London: Red Globe Press; 2020. 2. Brech E. Lessons in transition from refugee work: resilience and resourcefulness in a hostile environment. Online CPD resource: bit.ly/3wYjHgB 3. Tummala-Narra P. Cultural competence as a core emphasis of psychoanalytic psychotherapy. Psychoanalytic Psychology 2015; 32(2): 275-292 4. Macaskie J, Meekums B and Nolan G. Transformational education for psychotherapy and counselling: a relational dynamic approach. British Journal of Guidance & Counselling 2013; 41(4): 351–362. 5. Hammond A. Health and social capital. Sociology Review 2010; 20(2): 23-25. 6. Saad LF. Me and white supremacy: how to recognise your privilege, combat racism and change the world. London: Quercus; 2020. 7. Weiss H. Trauma, guilt and reparation – the path from impasse to development. New York: Routledge; 2020. 8. Karpman SB. Fairy tales and script drama analysis. Transactional Analysis Bulletin 1968. bit.ly/3CqDvum 9. Costa B. Other tongues: psychological therapies in a multilingual world. Monmouth: PCCS Books; 2020. 10. Bonanno GA. The end of trauma: how the new science of resilience is changing how we think. New York: Basic Books; 2021. 11. Bourdieu P. Sociology in question. London: Sage; 1993. 12. Heller, K, Dusenbury, L and Swindle RW. Component social support processes: comments and integration. Journal of Consulting and Clinical Psychology 1986; 54(4): 466-70.

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Counselling Changes Lives, 2

Counselling changes lives

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‘My magic mushroom trip gave me a new understanding of my fears’

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Judy Hanley describes her life-changing experience at a therapeutic psilocybin retreat

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ou’re doing what?! You’re going where?!’ was the general reaction when I told people I was off to the Caribbean to take magic mushrooms. I guess this wasn’t your average sunshine trip abroad, but then I don’t think magic mushrooms are your average Class A drug. They have been outlawed in the UK since the 1970s, but new research by Imperial College London and Johns Hopkins University, among others, is fuelling interest in the groundbreaking role that psychedelics can play in counselling and psychotherapy. Reports from these universities highlight, for example, the remarkable effect of psilocybin – the psychoactive ingredient within magic mushrooms – on people suffering from depression. Last year, Professor David Nutt, Dr Robin CarhartHarris and researchers at Imperial College published the findings of a flagship doubleblind trial comparing psilocybin with the SSRI escitalopram.1 The results showed psilocybin was equally as effective, if not more so, than the SSRI in treating depression. Further research projects are currently being undertaken in the UK and in North America into the scope of psychedelics in treating conditions such as alcohol and drug dependency, gambling addictions and eating disorders. The available results are astonishing, with trial participants reporting long-term psychological transformations and one of the most meaningful experiences of their lives. Spurred on by watching BBC Two’s groundbreaking documentary The Psychedelic Drug Trial, which followed

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participants in the Imperial College research, and reading Michael Pollan’s 2018 bestseller How To Change Your Mind,2 which highlights the emerging use of psychedelics in mental health, I decided to pack my suitcase and take a legal trip of my own. My encounter with magic mushrooms took place in Jamaica, where the use of psychedelics is not outlawed, as a professional observer at several psilocybinassisted retreats hosted by the experienced medical and therapeutic teams at MycoMeditations (www.mycomeditations. com). The location in Treasure Beach, an uncommercialised string of fishing villages on the idyllic Jamaican south coast, is breathtaking. But what proved to be more breathtaking is the view the mushrooms would give me of myself. In order to maximise the positive impact of hallucinogens in therapy, scientific and clinical literature emphasises the importance of ‘set’ and ‘setting’. Setting refers to the physical and psychosocial surroundings of the trip, including compatibility with the guide and/or facilitator, as well as the environment and comfort level in which the trip takes place. For me, that meant a quiet, shady spot on the Caribbean seafront, with an experienced facilitator by my side.

Set refers to the mindset of the person taking the psychedelic, with a particular focus on their fears, hopes, beliefs, personality, attitude towards psychedelics and what they expect from their trip. Having had the professional opportunity to witness several psychedelic trips at MycoMeditations before my own experience, I had deep faith in the ability of the mushroom to transform any destructive patterns of thinking. So, eight weeks into my stay in Jamaica, and after a thorough medical and mental health screening and pre-dose briefing session, I was ready for my own trip.

Personal power As I gazed at my dose of 3g of magic mushroom granules in my palm, I wondered how these innocuous-looking capsules could – as promised – fire up my brain’s synaptic responses, reawaken old pathways, create new ones, give me a sense of connectedness and generate personal insight. At this point, I was sensing a fear of surrendering my personal power to an external force – a remnant of my rebellion against a strict upbringing. I grabbed a glass of water, reminded myself to trust the mushroom, swallowed my capsules and waited. I glanced at my facilitator and nodded to her that I was OK. We talked, more to quell

The answer sent my head reeling. I didn’t need a ‘yes’, because as I asked my own therapeutic questions, the imagery changed swiftly and the rest of the trip moved at hyper speed, almost as if my brain was saying to me, ‘You get it! Now, let’s go, I’ve been waiting 55 years to meet you, we have a lot to do!’

Final chapter

my nerves than anything else. There was medical back-up close by should I need it, although I was told medical intervention is a very rare necessity. Within half an hour, my head started to feel heavy – it was time to lie down and lower my eye mask. Immediately, an intricate mesh of spiders’ webs appeared before my eyes, with each pocket of air filled with intensely iridescent greens, purples and blues. The webs moved through my vision as if on a conveyor belt, gathering speed. The colours merged into faces, all of them showing anger. None of them looked at me, until one of them surged towards me with teeth bared and eyes bulging menacingly. I felt rising nausea – it was too real. I remembered that I should embrace everything that approached me and not fear it, as it was there for a reason. In my head, I dared to step forward and hold out my hands, touching the face on its cheek. I was shocked to see its expression melt and become one of sadness, needing comfort. I wondered what had just happened and what it was that I was holding, because I then felt sadness, but I also felt the beauty and relief of acceptance and empathy for the soul before me. My trip moved on with pace. I was aware that there was an invisible being travelling along with me, a guide of sorts. Flying over

the earth, my body felt light and I felt free and unencumbered by the negative emotions that can often drag painfully at my throat. Suddenly, my shoulders were being pressed against the bed. Everything was dark – I felt like I was encased in a tomb, and panic streaked through me. Is this what a living death feels like? The nausea rose again, but I fought against the fear and, once again, trusted what was happening to me. My internal guide told me to push against the lid of my coffin. I stretched out my arm and it slid freely through the wall of my tomb. I was sucked out into the universe – to freedom, flight and an expanse so large and unconfined that I was unable to imagine it fully. I felt connected to an infinity that dwarfed the day-to-day minutiae of my life and made me wonder what really was important, why I worry so much, and why I see death as a definitive ending when I understand so little about life. I noticed that, although I had no control over what I was feeling and seeing, I had an awareness of what was happening and some power over how I interacted with my experience. This, I was told, is not always the case with hallucinogens, but it seemed to be something that my brain felt was important for me. I thought more about the faces I saw earlier, and I turned to my internal guide with some questions. Could I be meeting and accepting fractured parts of my self? And you, my guide, are you really my subconscious brain? Am I talking to you for the first time in my conscious world?

I have been pretty much obsessed most of my life with understanding my world – questions about life and death, how space can be endless, and how the smallest thing can be smaller still, and the largest thing can always become larger. The penultimate part of my trip took me through a black hole and out the other side. The weirdness of the trip was now my new normal, so there was no longer any fear or nausea. I experienced what it is like for time to stand still, for it to be endless. I sensed what infinity looks like, the shape of it. With the fear gone, I relaxed and waited for my final chapter. I took off my eye mask and looked around. Everything was as I expected it to be – the sea an intense, sparkling blue in front of me, the leaves on the trees a vibrant green, the birds singing louder than usual. Then I looked at the paving around my bed and it started to swirl. I was floating on terracotta clouds, and out of each paving stone emerged an emotionless face, looking straight through me. My internal guide told me to reach out and let them pass through me. So I did – hundreds of souls streamed up my outstretched arm and accelerated through me into the atmosphere. My whole body tingled and I felt a physical and mental strength I hadn’t felt since I was a child – a power that gave me the courage to do and say what I wanted to and what I felt was right. I sensed that fear could no longer control me. As I came down from my trip two hours from its start, I felt exhilarated. My facilitator noted the excitement in my voice and the energy with which I relayed my experiences to her. This all felt transformational and

‘I felt connected to an infinity that dwarfed the day-to-day minutiae of my life and made me wonder what really was important’ THERAPY TODAY

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Experience, 1

Experience

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Experience VERSION REPRO OP

‘The emotions that have chewed me up since I was a teenager, and fuelled many of my fears about life, have disappeared. I feel myself opening up’

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unlike anything I have ever been through before, in the therapy space or otherwise. I felt a warmth of connection to everyone and everything around me, and I had a new understanding of myself, including recognition of a latent fear that had quietly gnawed away at me for decades.

Accelerated learning ART PRODUCTION CLIENT

I have had many hours of personal therapy, plus supervision, during my training and practice as a therapist, but I have never had such depth and breadth of learning about myself in one session. A key question for me is whether I could have achieved such personal understanding through talking therapy alone. Arguably, yes. But would I have achieved it in a single session? Undoubtedly, no. It is important to note here that in no way do I believe that psychedelics should be a replacement for counselling and psychotherapy. In contrast, I feel therapy is the only way in which trip experiences can best be understood and integrated into everyday life. Therapy and psychedelics are in my opinion synergistic partners. In addition to the accelerated learning and ‘aha’ moments I experienced on my trip, I sensed that it was not just my mind that was talking to me but my body also. I was aware of tingling sensations, pressure on my torso, and of my whole skeleton being squashed as it passed through the gravitational force of my black hole. My mind and body were working overtly in unison, which, as I have spent most of my life being able to dissociate at will, is a comparatively new and refreshing experience. I felt normal, not strange. Several weeks on from the experience, one of the most significant lasting effects is that much of the anger I hold for people and events in my past – and something I have been working on in therapy for many years – has dissipated. The emotions that have chewed me up since I was a teenager, and fuelled many of my fears about life, have disappeared. I feel myself opening up

to new experiences; the trigger points that I have carefully avoided no longer have power over me. I can see them still, but they are insignificant. This is huge for me. The strangest outcome, though, is my ability to recall memories that I thought were lost for ever. My grandfather died when I was 11 months old. He was deeply loved by my whole family and his loss sent shock waves of depression through the generations for many years. I have always harboured a regret that I couldn’t remember him. I’m told he loved me, but I couldn’t recall feeling that love. That was until four weeks after my trip, when a clear memory of sitting on my grandfather’s lap came to me – I was reaching out for his spectacles, trying to touch my face in the reflection of his lenses. I felt immense happiness. After 54 years, I have my connection to my grandfather back. Even without the other mind-expanding experiences, my magic mushroom trip would still be worth it, if only for this one, hugely precious moment.

• Disclaimer: This article describes the

experience of one member which took place in a therapeutic facility in a country where the use of psilocybin is not outlawed. Members are however advised that psilocybin mushrooms are currently classed as a Class A illegal substance in the UK and BACP does not condone the use of illegal substances.

Psilocybin at a glance

■ In the UK, psilocybin, the active ingredient in ‘magic mushrooms’, is a Class A substance under the Misuse of Drugs Act 1971. Countries in which the use of psilocybin is legal include Jamaica, the Bahamas, Brazil, Samoa, Nepal and the Netherlands (as truffles). In the US, it has been decriminalised in several cities, including Oregon, Washington DC, Seattle and Denver. ■ Research into the use of psilocybin for the treatment of mental health conditions

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including PTSD and chronic depression is currently under way at Imperial College London,3 Kings College London,4 and Johns Hopkins University in the US.5 Study results so far have found psilocybin performed as well as escitalopram as a treatment for depression,1 and that decreases in depression seen after treatment with two doses of psilocybin, two weeks apart, lasted for 12 months after treatment.6 Ongoing research is also studying the effectiveness of psilocybin as a treatment for addictions and anorexia. ■ Although magic mushrooms are not considered addictive, there is a risk of adverse side effects in users, including hallucinations, panic attacks, anxiety and short-term psychosis.7 Some mushrooms can also be toxic to the kidneys.

About the author Judy Hanley MBACP is a person-centred therapist with a special interest in the role of psychedelics in mental health. She is currently training overseas as a facilitator and therapist, working with psilocybin.

REFERENCES

1. Carhart-Harris R et al. Trial of psilocybin versus escitalopram for depression. New England Journal of Medicine 2021; 384:1402-1411. 2. Pollan M. How to change your mind: the new science of psychedelics. London: Allen Lane; 2018. 3. www.kcl. ac.uk/research/psilocybin-trials 4. www. imperial.ac.uk/psychedelic-researchcentre 5. www.hopkinsmedicine.org/ psychiatry/research/psychedelicsresearch.html 6. Gukasyan N et al. Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: prospective 12-month follow-up. Journal of Psychopharmacology 2022; 36(2): 151. 7. Caronaro TM et al. Survey study of challenging experiences after ingesting psilocybin mushrooms: acute and enduring positive and negative consequences. Journal of Psychopharmacology 2016; 30(12): 1268-1278.

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‘I play video games like Minecraft with my clients’

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am a video game therapist working with young people online, which means I often use video games as a tool in my therapeutic practice. Sometimes this involves simply talking about video games with clients. For example, if a client mentions they like playing Fortnite, I might ask them what character they like to play, and this might lead into an exploration of their self-identity. A client might show me the island they created in Animal Crossing during lockdown, and we could explore how it compared with their real lockdown life. I also play video games like Minecraft with my clients. I don’t think there’s anything that can quite beat the experience of playing a video game with a client – being able to embody a character next to them in a game and watch a sunrise, play hide-andseek or battle monsters together. Playing Minecraft produces rich material for therapeutic work. For example, I always ask clients to create a safe place in the game in their first session. How each client interprets this request, what they create (a cave, a castle) and how they create it (fast, slow, roughly, trying to make it perfect) provide a lot of information for us to work with. Video games are no longer a minority pastime; they are mainstream – in 2021 there were three billion gamers worldwide1 (that’s close to half the population of the world!). For me it feels like a natural transition from using tools like digital sandtrays to providing therapy to a client in a video game they know and love. By using video games in my practice, I can see that I’m engaging young people in therapy who would otherwise never have engaged; they are maintaining their engagement, enjoying their sessions and having a positive experience of counselling. I’ve done training in how to recognise when someone is potentially being harmed by their gaming and how to support them. I think it helps clients that I’m coming from an open-minded place where I can see the positives as well as the negatives of gaming. I have played Roblox, Fortnite, Among Us and Animal Crossing with my clients. However, Minecraft

is the game I would recommend the most in terms of providing the safest, most accessible platform in which to meet clients. If you’ve never come across Minecraft, the best way to describe it is that it’s like digital LEGO®, a digital sandtray2 and a heap of adventures all rolled into one beautiful game. Rather than moving through a bunch of levels and completing tasks, you can go wherever you like in the game and do whatever you want – fly, swim and build whatever your imagination can dream of. Video game therapy won’t be in every counsellor’s comfort zone, and to provide a safe and accessible environment you do need to be comfortable with the technical side of things and to be able to keep calm when things go wrong. I’ve had to troubleshoot a lot of technical issues that have come up for my clients. At the same time, you have to think about the emotional and therapeutic elements of the technical hitch. For example, the question, ‘What does this bring up for the client that they’ve been kicked out of the game all of a sudden?’, can be tricky to hold in mind while you are also trying to figure out the technical reason for why they have been kicked out. You also have to be confident in how to protect a client’s confidentiality and their data within the video game. I can see on the horizon that there will be a wave of clients and therapists alike who embrace this way of working. Last year I was getting more enquiries than I could take on myself, so I decided to start training professionals to build a network of video game therapists in the UK. Cambridge Social Ventures at the University of Cambridge is supporting me to set up a social enterprise to develop my training and conduct research into the efficacy of video game therapy. I’m excited about the adventures to come. REFERENCES

1. Newzoo. Global Market Report June 2021. www.newzoo.com/key-numbers 2. Finch E. Using Minecraft as a sandtray. In Stone J. Digital play therapy: a clinician’s guide to comfort and competence. New York: Routledge; 2022 (pp.190–192).

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About the author Ellie Finch MA is a counsellor and social worker who specialises in supporting parents and siblings of children with additional needs. She provides consultancy and training to professionals and organisations who wish to use video games in their practice. www.elliefinch.co.uk

If you would like to share how you work in the ‘My practice’ column, email therapytoday@ thinkpublishing.co.uk

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THE MYTH OF THE GOOD WHITE COUNSELLOR

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Believing that you ‘don’t see colour’ doesn’t exclude you from racism, says Dr Ruth Smith

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n recent times, the reality of racial inequality has been brought to our attention in a way that it has arguably not been since the Civil Rights era. The murder of George Floyd and the subsequent Black Lives Matter protests have brought the issues of race and racism into mainstream consciousness and provided an opportunity for white people to not only learn about race but become anti-racist. In a white-dominated profession such as counselling, this moment of history is a chance for the racial status quo to be challenged. But it is my personal and professional experience that not only do counsellors resist talking about race because, they say, they ‘don’t see colour’, they also believe that their innate ‘goodness’ as a counsellor precludes them from being racist. I have called this the phenomenon of the ‘good white counsellor’. In this article, I will present its characteristics and ask readers to read with an open mind and question whether they may consider themselves to be a ‘good white counsellor’. First, it is important to state that I am a white woman and a qualified counsellor who has been engaged with understanding whiteness since 2015 when I started working with refugees and asylum seekers. My master’s research in counselling and psychotherapy practice considered the experiences of counsellors engaged in cross-racial counselling. I then completed a PhD, which explored how white trainee counsellors in South Wales understand race, racism and whiteness, using the theoretical lens of critical whiteness studies. This doctoral research was inspired by my own experience as a white counsellor working with refugees

and asylum seekers during the refugee crisis in 2015, the rise to political prominence and then power of Donald Trump in the US and the Brexit referendum here in the UK. On both sides of the Atlantic, the political rhetoric became more nationalistic. I was working with clients who were experiencing verbal abuse and a pervasive sense of not being wanted on a daily basis, and bringing it to their sessions. As a white counsellor who had spent most of my life with a de-racialised identity, and a belief that ‘not seeing colour’ – a colour-blind racial attitude – was the correct way to approach race, I began for the first time to question what my whiteness might represent to the clients I was working with, and how I could support them with the racism they were experiencing in a way that was not harmful. Thus began my personal and academic engagement with race. However, I found that I was met with silence from colleagues and peers who did not want or know how to talk with me about race and whiteness. Moreover, it felt like I was being ‘bad’ for openly engaging with whiteness and race. I was curious to explore this silence and resistance, so my

‘I was met with silence from colleagues and peers who did not want or know how to talk with me about race’ THERAPY TODAY

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doctoral research focused on white trainee counsellors’ understanding of race, racism and whiteness. To do this, I undertook ethnographic research, becoming a participantobserver on a counselling course with 16 white trainees in South Wales. I also held semi-structured interviews and did a document analysis of training materials. What links my personal experiences of training and practising as a counsellor with my research findings is the existence of pervasive colour-blind attitudes toward race within the counselling professions.

What race means Before I address my claim about blindness to colour in counselling, it is important to be clear what is meant by race, as my research found that there was a lack of clarity around the word for my research participants. I believe that a lack of understanding about what race means is the cornerstone of being a ‘good white counsellor’. Race is often misunderstood as a genetic or biological factor, something that separates people into distinct groups that we can identify through physical characteristics such as skin colour. In reality, race is a socially constructed idea that can be traced back to the 18th century, during the Enlightenment period, when there was an emerging interest in trying to understand the world through a scientific perspective, rather than a religious one. Of the many white, male, Enlightenment scientists who put forward their theories of race, one of the earliest and most influential was a botanist called Carl Linnaeus, who created a hierarchy of human beings based on skin colour. Linnaeus put the white ‘Europeus’ at the top of his hierarchy and the black ‘Afer’ at the bottom, and gave

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to the Europeus positive characteristics, such as being well mannered and sanguine, and to the Afer, negative attributes such as being crafty and lazy. The false concept that white people are intellectually, morally and aesthetically superior to other races provided the perpetrators with justification for the slave trade, colonialism, the Eugenics movement and the Holocaust. The historical legacy of the social construction of race is the belief by white people that they are ‘normal’ and that race belongs to ‘other’ groups of people. Therefore, although ‘race’ is not scientifically real, the notion of it has real consequences. As Jensen states: ‘Race is fiction we must never accept. Race is a fact we must never forget.’1

The post-racial myth PRODUCTION CLIENT

The second characteristic of the ‘good white counsellor’ is a belief that race does not matter. Since the post-Civil Rights era, many white people have believed we are living in a post-racial world, where race is inconsequential to getting on in life, and that character takes precedence over skin colour. Moreover, the notion that for white people to see or speak about race is to be racist is a misconception that many white people hold. This is known as colour-blind racism, a form of discrimination about which the scholar Eduardo Bonilla-Silva has written extensively.2 He argues that colour-blind racism contains four central frames. The first, ‘abstract liberalism’, is a belief that everyone has the same opportunities if they work hard enough – a ‘pull yourself up by your bootstraps’ attitude. This ignores the fact that racial discrimination means that people of colour are treated unequally through all strata of society including education, healthcare (including mental healthcare) and criminal justice systems. The second, ‘cultural racism’, blames the lack of progress on stereotypical generalisations of people of colour. The third frame is ‘minimisation’, where understanding of racism is reduced to include only obvious forms, such as physical violence; covert forms, such as microaggressions and institutional racism, are not acknowledged or accepted.

‘Participants were unsure what racism meant but certain that to “see” race was not acceptable and potentially racist’ Finally, ‘naturalisation’ echoes Enlightenment thinking with a false belief that it is natural for groups of people to ‘stick with their own kind’. Bonilla-Silva calls this colour-blind racism ‘racism without racists’, as those who hold this view do not think of themselves as racist. US scholar Shannon Sullivan has written about colour-blind racism and how it is enacted by ‘good white people’.3 This refers to white people who perceive themselves as being educated and liberal and show their empathy towards people of colour by not discussing race. ‘Good white people’ believe that racism is something that bad white people do: the uneducated, overtly racist and violent. I admit that I once believed that to see race was to be racist and for most of my life I would have been in the category of ‘good white person’.

Being blind to colour The foundations of being a ‘good white person’ and a ‘good white counsellor’ are built on a moralistic belief that the colour- blind approach is a correct way to understand race. This was reflected in my participants, who were confused and hesitant in racial discourse but unanimously expressed colour-blind statements. They confused racism with other forms of discrimination, such as xenophobia and homophobia. This semantic confusion caused feelings of self-consciousness in the participants when trying to engage in racial discourse in the interviews. However, where the participants felt more confident was in their colour-blind statements, such as ‘I don’t really think about race. I make my judgment on the person, not on their

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colour’. It seemed as though the participants were unsure what race and racism meant but were certain that to ‘see’ race was not acceptable and was even potentially racist. This was reinforced by race being avoided in the classroom during my participant observations. It only came up twice – once when a student mentioned they would not want to work with a racist or homophobe, and again when the students watched a YouTube video of a session between a black client and a white counsellor for the purposes of seeing how to contract a session. When asked to discuss the video, the racial difference between the client and counsellor was not mentioned and the comment about not wanting to work with a racist client was met with a brief discussion that quickly fizzled out. However, this is not to say that the participants are unique in taking a colour-blind approach. One of the earliest contributions to the topic of counselling and race can be found in two recorded counselling sessions between the personcentred counsellor Carl Rogers and a young, unnamed African-American man in 1977. The client was in remission from leukaemia but his primary concern was the race conflict he felt existed in American society and his perception of himself as a victim within that conflict. Lee states, ‘It is obvious that his Blackness and his experience of it is at the root of the issue,’ which Rogers repeatedly overlooks and fails to explore with the client.4 It could be argued that Carl Rogers did not ‘see’ his client’s race or recognise his sociopolitical context. More contemporarily, BACP’s own Ethical Framework5 and course accreditation guidelines6 do not currently mention the words ‘race’ or ‘racism’ (although the latter is currently under review by BACP’s Equality, Diversity and Inclusion Task and Finish Group), using instead umbrella terms such as ‘diversity’ and ‘culture’. This means that race risks being unseen and therefore not spoken about in training and practice. Indeed, white people (and arguably organisations) may avoid using the word ‘race’ due to their own discomfort and replace it with words such as ‘culture’.7

The benevolent myth When I asked the participants how they would describe a counsellor, they used descriptors such as ‘kind’, ‘sweet-natured’ and ‘warm, welcoming, safe’. One said that counsellors have got an ‘openness about them and a softness’. That this cohort assigned benevolent characteristics to counsellors is not surprising, given they were in training and this perception of goodness may have influenced their decision to train as a counsellor. It was encountering this assumption that all counsellors are good people, combined with the pervasive colour-blind attitudes I identified in my research (from individuals to organisations) that sparked the development of the theory of the ‘good white counsellor’ narrative that I have presented in this article. Effective racial discourse among colleagues, trainees and with clients will not take place in a profession made up of white people who are mostly ‘good white counsellors’. This may explain why counselling training can result in the exclusion of black trainees’ experiences, suppression of their learning needs, and exposure to expectations from white trainees to provide expertise around race.8 This silence around race can lead to feelings of isolation, shame and selfcensorship in counsellors of colour.9

Challenging the narrative One way to confront this ‘good white counsellor’ professional narrative can be found in challenging the good/bad dichotomy of racism, whereby only ‘bad’ people are racist and ‘good’ people are not. Trepagnier suggests we should

‘To be blind to someone’s colour is not a kindness but a denial of their lived experiences, stifling racial discourse’

see racism as existing on a continuum of ‘more’ or ‘less’ racist, rather than racist or non-racist.10 By inference, it allows you to not be wholly ‘good’ or ‘bad’ and allows colour-blind attitudes to be challenged by accepting that learning about race is a lifelong commitment. I see my own experience of developing white awareness and anti-racist allyship as one of continual learning and selfreflection and balancing the need to speak out as a white person without centring myself in racial discourse. Here, counsellors are at an advantage with their skills of listening and reflexivity. Selfexploration of the more uncomfortable aspects of your personality is a natural and necessary process for counsellors, and I argue that this can be extended to developing racial awareness. However, from my own experience, developing racial awareness can often be met with resistance and suspicion from other white people, as you are positioned as a ‘bad’ white person for ‘seeing’ race. For this to change, there needs to be more clarity among white counsellors (trainees, tutors, practitioners and supervisors) about what race and racism mean, along with an understanding that to be blind to someone’s colour is not an expression of kindness toward people of colour but a denial of their lived experiences, stifling racial discourse and delaying progress toward racial equality. However, to challenge this blindness to colour among white individual counsellors effectively, I believe it also needs to be challenged organisationally. This would require race and racism to be incorporated in official training and practice guidelines and for white counselling tutors/lecturers to become racially cognisant and equipped to teach about race, racism and whiteness in the classroom. Consequently, white counsellors would really be able to see and listen to counsellors and clients of colour, for whom racial inequality and injustice have been overlooked for too long by ‘good white counsellors’. I’d like to end this article with a question for white readers – are you a ‘good white counsellor’ and are you willing to do the work to challenge this in yourself, in others and in counselling? ■

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About the author Dr Ruth Smith lives in South Wales and was awarded her PhD in social justice from the University of Wales, Trinity Saint David in 2021. Ruth’s research interests are critical whiteness studies, epistemologies of ignorance, sociopolitics and social justice. She is happy to receive further enquiries about her research. RuthK.Smith@outlook.com

REFERENCES

1. Jensen R. The heart of whiteness: confronting race, racism and white privilege. San Francisco: City Lights; 2005. 2. Bonilla-Silva E. Racism without racists: colour-blind racism and the persistence of racial inequality in the United States (5th ed). Lanham: Rowman & Littlefield; 2018. 3. Sullivan S. Good white people: the problem with middleclass white anti-racism. Albany: State University of New York Press; 2014. 4. Lee CC. Twenty-first-century reflections on ‘The Right to be Desperate’ and ‘On Anger and Hurt’. In: Moodley R, Lago C, Talahite A (eds). Carl Rogers counsels a black client. Ross-on-Wye: PCCS Books (pp228–230). 5. BACP. Ethical Framework for the Counselling Professions. Lutterworth: BACP; 2018. 6. BACP. Accreditation of Training Courses. Lutterworth: BACP; 2012. Available at: www.bacp.co.uk/ media/1502/bacp-course-accreditationcriteria.pdf 7. Matias CE, Montoya R and Nishi NWM. Blocking critical race theory (CRT): how the emotionality of whiteness blocks CRT in urban teacher education. Educational Studies 2016; 52(1): 1-19. 8. McKenzie-Mavinga I. Black issues in the therapeutic process. Basingstoke: Palgrave Macmillan; 2009. 9. Jackson C. Black matters. Therapy Today 2020; 31(7). 10. Trepagnier B. Silent racism: how well-meaning white people perpetuate the racial divide. Abingdon: Routledge; 2016.

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Debate, 2

Clinical concepts

VERSION

Please join our ‘Talking point’ panel! Email therapytoday@ thinkpublishing.co.uk

REPRO OP

Returners How do you feel about clients coming back?

SUBS

‘It often surprises me to hear what a client has held onto’

ART PRODUCTION CLIENT

I recently – unusually – had a number of clients return within a few weeks of each other. Reasons for returning varied, but one client summed it up as a need to ‘dock in the harbour’ for a few sessions. I have noticed that returning clients are often the ones who, when they first came, expressed how reluctant and ashamed they felt about needing therapy. The return can be about exploring deeper issues over a longer period of time that they weren’t ready to address the first time around. For children or adolescents, a return often signals a time of transition, such as a school move, transition to college or university, a family breakdown, change in foster placement or friendship challenges. I always start with an assessment and contracting on a return but I do find that returning clients are much quicker to get into the work – the groundwork of trust and establishing the therapeutic alliance has already been laid. It often surprises me to hear what a client has held onto and remembered from our first work together. It’s wonderful to learn that they have been able to use a strategy or recall a metaphor when things have been tough and that it has helped them – it shows the power of the therapeutic work. Georgia Swift, psychotherapist working with adults, young people and families

‘Breaks in complex work are often necessary’ When reflecting on my therapeutic practice, I realise I have become increasingly comfortable with the phenomenon of clients returning to therapy, reminding myself that we all have different needs at different times. Some clients come into the work prepared to commit long term; for others, a few sessions will suffice; another group, me included, prefer to dip in and out as required. I recall in my early career a sense of shameful inferiority when a client decided to leave to see another therapist, only to be replaced by a feeling of superiority when they returned having not found the experience as they had imagined. As I became more experienced and developed confidence in my particular style and ability, I began to trust more in the process, and be more resolute in my belief that the client inherently knows what they need, even if they are not always cognisant of this. Latterly, my research interest has been sparked by clients who have suffered from adverse childhood experiences and the link I was noticing to the development of their personal agency. With this particular client group, breaks in the complex work are often necessary and their ability to trust when best to have them can be indicative of a client’s developing agency. While many children and young people reappear in counselling as they go through the various developmental stages of childhood and adolescence, clients may also return because they feel safe with a trusted therapist, ready to take the work to a deeper level. Comfort Shields, psychodynamic and humanistic psychotherapist

‘I do feel an obligation to find space for returning clients’ I enjoy working with returning clients. Some of my clients choose to start their therapy with a short-term piece of work, perhaps to learn healthy coping strategies that they can take away and add to their ‘toolkit’. It is not unusual for a client to contact me months later to build on the foundations from their previous therapy. I feel pleased that they have chosen me to support them with this. Other returning clients may have had a change in circumstances or wish to increase their self-awareness. Whatever their reasons, I am curious when a past client contacts me. I enquire about their return, and we can explore what has changed, what this new piece of work might look like and what they wish to achieve. Returning to therapy can feel empowering for clients and helps support their self-care. During client endings, if they ask about the possibility of returning, I advise that they are welcome to make future contact and, if I have the availability, we would be able to work together again. If I don’t have space, there is the choice of an onwards referral. I do, however, feel an obligation to find space for returning clients, particularly if we have worked together on a long-term basis. I recognise that this is something for me to reflect on in supervision – to find a balance between holding my boundaries, supporting my clients and maintaining my own self-care. Nikki Kelly, Gestalt counsellor and supervisor in private practice

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Talking point

My clients have invariably experienced trauma, either in their childhood or through intergenerational trauma, so to have the possibility of coming back if that’s what feels right, and to know this is an option, may be appropriate. When attachments have been painfully lost or broken, it’s a privilege to offer clients the very best of care, whatever that looks like to them. For some, it’s good to move on and have the opportunity to experience a relationship with another therapist. The body of work we have undertaken helps them create another connection, building on what we’ve shared. I like the freedom of private practice to reach a clinical decision based on ongoing assessment in collaboration with each client. As I progress in my career and gain confidence in working more creatively, I can focus on what feels right for each and every client, trusting in their agency and our relationship. My returning clients also have the option of a single session rather than being committed to weekly therapy once more. It can also result in them being seen more quickly, as having to wait for a regular space can take a while when the majority of my work is long term. I hold a specific space in my diary for this.

ELLY WALTON/IKON IMAGES

‘For some clients, knowing they can return offers comfort’ I welcome returning clients to my practice as I believe that therapy should be a constant support for the maintenance of wellbeing. For some clients, knowing they can return simply offers comfort, and for others, it may be about exploring a deeper layer to the work that relates to previous themes. Many clients have said the thought of starting at the beginning with someone else can feel daunting, but if I had a full caseload, I would not feel pressured to squeeze them in. Generally, they are happy to wait until I have availability. When I worked for a charity that supported women with complex mental health needs, we often saw clients return many times, although they could rarely see the same therapist. It seemed to work well, possibly because the work was shorter term, and it also offered an opportunity for clients to experience a different therapeutic modality. In my EAP work, the issue of returning clients is more complex, as most EAPs have restrictions in place that prevent therapists from working privately with EAP clients for at least 12 months, if at all, after the initial EAP work has finished. If a client asks whether they can continue with me privately, I manage it carefully, explaining the regulations and reasons for them, and I also let the EAP know that the conversation has taken place. Gemma Mitchell, counsellor and supervisor in private practice

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Savita Nayyar, therapist in private practice

THIS MONTH’S TALKING POINT IS COMPILED BY SALLY BROWN

‘My returning clients also have the option of single-session therapy’

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VERSION

The bookshelf

REPRO OP

For exclusive publisher discount codes, see www.bacp.co.uk/membership/book-discounts Three Characters: narcissist, borderline, manic depressive Christopher Bollas (Phoenix, £17.99)

SUBS ART PRODUCTION REVIEWS COMPILED BY JEANINE CONNOR

CLIENT

In the introduction to this compelling book, Bollas makes clear that it is based on three of his regular lectures given to students of psychoanalysis. Anyone unfamiliar with analytical writing might find some of the framing challenging, so the book might require additional reading. However, in order to make the chapters more digestible, each is broken down into salient subheadings. Also included is a list of axioms, which help us to notice a client who may present as one of the characters. At the end of the book is a great discussion section in which I found more clarity, as it answered questions I had formed during reading. I highly recommend earmarking this to read as you finish each chapter. Chapter one covers the positive and the (often overlooked) negative narcissist. I was struck by the point raised of how the narcissist wants to dismiss their pain, in comparison with the borderline in chapter two, who seeks it. Bollas keeps for last the manic depressive, a diagnostic label not often used and oftentimes replaced with bipolar. They are explained as similar yet different conditions and that mislabelling impacts the treatment of manic depression, which is then explored. Bollas methodically explores why each character may seek therapy and the clinical issues and therapeutic challenges therapists may encounter in the therapeutic engagement. The chapters are a wonderful way of thinking about object relations in action. There is a sense of academic surety in Bollas’ psychoanalytical explanation, which, as an integrative counsellor, does not always sit easy with me. These lectures inspire me to know more, and I imagine most readers will feel the same. Have a notepad and pencil handy! Gavin Conn is a counsellor in private practice in London

Intimacy, Sex and Relationship Challenges Laid Bare Across the Lifespan: applied principles and practice for health professionals Judy Benns, Sue Burridge and Jean Penman (Routledge £29.99) The authors set out to encompass the full human lifespan from the perspective of sexual development and sexual relationships. They cover a wide range of significant topics and use for illustration more than 80 vignettes from a variety of healthcare settings. To these they apply a two-stage structure of ‘reflect and respond’ as a way of drawing out key issues and responses. According to the publisher, the book is ‘demonstrating how being open to talk about sex and intimacy can change lives’, and the authors succeed in illustrating this through case studies. However, in most examples, responses are limited to providing a safe space and opportunity for the person to speak, while the health professional applies good-quality, basic listening skills. This is standard practice for counsellors. I would have much preferred a deeper and more detailed exploration of fewer cases from a therapeutic intervention perspective. While I enjoyed some of the case examples, I found little in the material about sexual development, relationships or challenges that was new to me, even though this is not an area in which I have specialist knowledge. I anticipate that many counsellors will be familiar with most of the material. For others, it may start to fill gaps in their knowledge, but only at an introductory level and not all the chapters offer a good number of references and suggestions for further reading. The authors are no doubt aware of the knowledge level of the general health professionals it is aimed at and have pitched their book accordingly. Steve Page MBACP (Accred) is a counsellor and coach in private practice

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Wild Therapy: rewilding our inner and outer worlds (2nd edition) Nick Totton (PCCS Books, £20.99) The first edition of Wild Therapy was published in 2011, when many of us would undoubtedly have been unfamiliar with the concepts it covered. Much has changed in the intervening period, with issues such as climate change and the COVID-19 pandemic now high on our collective agenda, so this second edition feels timely. This is a wide-ranging book, spanning ecology, philosophy, literature, anthropology, psychology and psychotherapy in order to show how distanced we have become from our natural environment. Nick Totton explores the importance of ‘wildness’ in both our environmental surroundings and our internal worlds, and argues that therapy and other mediums can offer connection between the two. The book is well researched and referenced. This edition contains a new chapter, ‘Living through the Anthropocene’, about how we can live with the anxiety created by the current environmental crisis. I was also particularly interested in chapters nine and 10, which explore the author’s view of wild therapy in more detail. They provide interesting and reflexive examples from practice, in which Totton challenges the therapeutic boundaries we would usually take for granted. For example, he regularly works outside in gardens, fields or woods, and advocates a need for what he describes as ‘boundlessness’. The book questions much of what we accept as orthodox in the therapy profession. While I don’t agree with all that Totton writes, I think it is important to engage with ideas from opposing polarities. Totton provides a well-argued case and a thought-provoking read for both qualified and trainee therapists and practitioners from complementary disciplines too. Anne Gilbert is a Gestalt psychotherapist and supervisor

The Bookshelf, 1

Reviews Please note, we do not accept unsolicited book reviews. To join the review panel, email therapytoday@thinkpublishing.co.uk

The Change Process in Psychotherapy During Troubling Times Sue Wright (ed) (Routledge, £29.99)

The Power of Talking: stories from the therapy room Stelios Kiosses (Phoenix, £19.99)

The aims and objectives of this themed collection are set out by Richard Davis, one of the contributors, in an opening chapter that offers a lucid, helpful overview. These selections – which we’re encouraged to read slowly, in a spirit of therapeutic dialogue – set out to examine how individuals, families and communities come to terms with the past, including the transformation of traumas and losses. Within this larger topic, individual practitioners address specific themes. Sue Wright investigates how supportive witnessing from a skilled therapist can enable a client, burdened by traumatic early experiences, to experience a ‘transformative revitalisation of past and present’. Philippa Smethurst offers a case study that shows how ‘a person with a trauma history can find transformation through a body-first approach’. Richard Davis writes about the transition experiences of psychotherapy trainees, which, archetypally speaking, parallel the initiation processes of some cultures. Steffi Bednarek addresses whether our current climate emergency calls for a new paradigm at the level of our profession, as a whole, as we both theorise and practise it. The aim of this book is admittedly large and, inevitably, not every contribution will feel equally relevant for any given reader. This may account for my vague but perceptible sense of disappointment – the whole is less than the sum of its parts, perhaps? That said, there were some insights – particularly in Liz Rolls’ and Sue Wright’s dialogue on traumatic loss, and in Jeremy Woodcock’s essay on ‘extreme events, time, liminality and deep subjectivity’ – that directly influenced and informed how I work with traumatised clients. In this sense, there’s a lot to recommend about this book. David Curl MBACP is a counsellor and trainer in private practice

It’s intriguing to get a peek behind another professional’s therapy room door. Here, the TV psychologist and presenter of Channel 4’s The Hoarder Next Door introduces five case studies with presenting issues including somatisation, depression, addiction, bereavement, marital discourse, the lesser-known condition of sexsomnia, the lesser-acknowledged phenomenon of female sexual abuse and, not surprisingly, hoarding. These are bookended by chapters ‘On being a therapist’ and ‘Final thoughts’. Kiosses offers insight into how he works, in the therapy room and online, using an integrative approach incorporating CBT, psychodynamic and transtheoretical models. The straightforward definitions would be useful for the novice therapist, trainee or layperson. The author weaves in concepts of projection, denial, object permanency and vicarious trauma. He refers to timekeeping, culture and lockdown. There were statements that rang true, such as, ‘what stands in the way becomes the way’, and others that didn’t, such as, ‘flying with a client who has a fear of flying as the final step in the therapeutic intervention’, and I questioned the assertion that risky behaviours, including suicidal ideation, ‘are not generally suitable’ for online work. Sometimes the text felt clumsy, with theoretical descriptions presented as if they’d been spoken to the client, when really the author was addressing the reader. This was particularly apparent in chapter four, about a couple, which also had several typos. Chapter six, the one about hoarding, presented an inconsistent narrative, which was confusing and, therefore, seemed disingenuous. There is perhaps too much packed into its 140 pages, and it would have benefited from more rigorous editing. Jeanine Connor is a psychotherapist and supervisor

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The book that shaped my practice

I and Thou Martin Buber (Continuum, 1937) This book was recommended reading when I trained as a counsellor, although I had previously studied Buber’s work while doing a biblical studies degree. It’s a slim volume that contains much wisdom. The main thrust of the book is that, at the heart of any relationship, the deepest connection comes when we go beyond the ‘I – it’ approach, which sees ‘other’ as a means to an end, and move to a relational ‘I – thou’ approach. It is in that space, between us and the other, that meeting and connection happen. It’s where our uniqueness and that of the other meet and become present. For me, relational depth underpins everything. Initially, that space can feel tricky, but as we continue to work like this, the connection deepens and the transformative magic of counselling happens. Joanna Burridge is an integrative counsellor and spiritual companion

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Dilemmas VERSION REPRO OP

OUR ETHICS TEAM AND THERAPY TODAY READERS CONSIDER THIS MONTH’S DILEMMA:

SUBS

IF ADOPTION COMES UP WITH AN EXISTING CLIENT, DO WE ALWAYS NEED TO REFER THEM TO AN OFSTED REGISTERED COUNSELLOR?

ART

I have been seeing a client for 10 weeks so far, the presenting issue having been their relationship and ambivalence over whether to stay with their partner. Some way into the therapy, the client started to explore their feelings about being adopted and is considering trying to trace their birth family. This was not mentioned at the time I accepted the (self-)referral. I’m not registered with Ofsted as an adoption therapist, so I am unsure as to whether I can continue working with them, but it seems wrong if I am expected to ‘drop’ them at this stage, when the work is far from complete.

PRODUCTION

Stephen Hitchcock, BACP’s Ethics Consultant, replies: This is a complex

CLIENT

issue, and BACP is currently in contact with a number of adoption agencies and other stakeholders in an attempt to address this with Ofsted and get clarification. Meanwhile, the current guidance continues to apply. First, you need to be competent to deliver the services being offered (Ethical Framework Good Practice, point 13), and to work within the law (points 14f and 46), under the jurisdiction of the country in which you operate. Since 2010, under an amendment to the Adoption and Children’s Act 2002, in order to work on any issue directly related to adoption, you need to be registered as an Adoption Support Agency (ASA) or to be employed by one or working under a contract for services with one. As defined by Ofsted:1 ‘An adoption support agency must register if it carries out one or more of the following activities: ● assisting an adoption agency in preparing and training adoptive parents ● supporting any child or adult who has been adopted, or their birth relatives ● supporting and helping adoptive parents to enable them to provide stable and permanent homes for children placed with them for adoption and when they are formally adopted ● assisting people who have been adopted to have contact with their relatives, including assisting people to trace adopted relatives.’

In England, the law states that a counselling practitioner must not provide any counselling, advice, assistance and information in which the main focus of the work is on an adoption-related issue, unless the therapist is either: ● registered as an adoption support agency with Ofsted, or ● working as an employee or under a contract for services with an adoption support agency, and ● the therapy work undertaken is in the context of that employment or contract. In Wales, similar principles apply, and registration is with the Care and Social Services Inspectorate in Wales (CSSIW), and you should contact CSSIW, your local authority, or a local registered adoption support agency if you need help and advice. In Northern Ireland, registration is currently with the Department of Health through the Regulation and Quality Improvement Authority (RQIA). However, the law here is changing and practitioners are advised to take legal advice and/or check with the Department of Health or the RQIA to determine any conditions required to provide the adoption-related counselling services you wish to offer. In Scotland, you should obtain legal advice and/or check with your local authority to determine any conditions required before providing the adoption-related counselling services you wish to offer.

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What seems to be the key question here is how central is the issue of adoption in whatever the client wishes to explore? If you are not registered as an ASA, employed by one, or working under a contract for services with one, and in the course of working with a client an adoption-related issue unexpectedly arises and is likely to become the main focus of the work, you are best advised to discuss the legal requirements with the client and then, with the client’s consent, consult with an ASA and/or the relevant statutory or regulatory body and consider referring the client on. The term ‘adoption-related issue’ includes not only work with children or adults who are currently involved in the adoption process, but also work with any adults who were adopted or adopters in the past, or their relatives or siblings, who now need therapeutic work and support in adulthood. The problem comes when local services and referral options are limited, or when it is unclear whether adoption is the main focus of the work. If a client is wanting help with family tracing or contact with their birth family, for example, it is more obviously an adoption-related issue outside the scope of your practice. However, if a client mentions that they are adopted and wants to explore the impact of their past experiences, you might be appropriately qualified and competent to continue working with them yourself. The therapeutic relationship may already have been established, and it could do more harm than good to bring the work to an abrupt end and leave the client without support. BACP’s ethical principles of ‘being trustworthy’, ‘autonomy’, ‘beneficence’ and ‘non-maleficence’ are of particular relevance here, together with our commitment to make clients our primary concern. And in the words of Ofsted: ‘You do not have to register if an adoption-related issue only emerges after counselling begins and is not the primary concern or focus.’ 1 In either case, clients should be made aware of their rights to access adoption support services from a registered ASA. In the situation that you describe, it would seem appropriate to refer your client to a registered ASA for their birth family tracing, but to consider whether you could continue working with them on their ‘feelings about being adopted’. Your own training, skills and experience might be sufficient to work competently and effectively with such issues. With regard to working on the less clearly defined adoption-related issues, you

Dilemmas, 1

would need to exercise your professional judgment, assess your competence, consult with your supervisor and perhaps with a local registered ASA, and consider seeking legal advice, for example via your professional indemnity insurer. BACP will continue to work to secure further guidance in order to provide clarification and to help to resolve this perennial issue. REFERENCE 1. Introduction to Adoption Support Agencies [Guidance]. London: Ofsted; 2021. bit.ly/3ASjDkx

Stephen Hitchcock MBACP is a senior accredited counsellor and supervisor with 20 years’ experience, and has a private practice in the Lake District. Stephen previously worked with BACP’s Professional Standards department as an accreditation assessor and a moderator. This column is reviewed by an ethics panel of experienced practitioners.

READER RESPONSES ‘It is crucial therapists recognise the limits of their competence’ I qualified as a therapist in 2013 but had a personal interest in adoption, so in 2017 I gained

Ofsted registration by training with Barnardo’s as part of their LINK Adoption Support Service. I also completed Barnardo’s attachment focused therapy training. The training was excellent; probably the most thorough I have undertaken since qualifying. Sadly, I have had clients who have not been informed that this is a protected area, and some have been inappropriately advised or experienced struggles with the therapeutic relationship with a counsellor who is not Ofsted registered. The issues that emerge in work like this can be complex, encompassing a wide range of loss, including the loss of extended family as well as the more obvious loss of birth parents, and the loss of family history, shared genetic knowledge and religious and cultural heritage. Adoptees may also be unaware of how trauma has shaped their attachment to others, particularly those with ‘I will reject you before you reject me’ patterns of behaviours, so it’s important there is an understanding of attachment and how that may present in different relationships and different life stages. Retraumatising the client could easily happen, leading to a loss of trust, which may influence the success of any future therapy. The possibility of a client seeking a reunion with their birth family opens up a whole number of potential issues. My training has given me an understanding of both the therapeutic and legal side, and the services that can guide and support clients in this process. Access to birth records is not straightforward as birth families have rights and the process is lengthy. Receiving a file from the agency responsible for the adoption can lead to finding out previously unknown personal information, which may be traumatising or, alternatively, frustrating if the information has been redacted. Birth parents do not have to give permission to be contacted. Discovering relatives can be thrilling but contact needs to be handled sensitively as they may not be aware of the existence of an adopted relative. The use of an intermediary is

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advised to allow the person the client is approaching time for reflection and discussion and to consider the implications for them. The reasons for contact need to be carefully explored – what if it doesn’t go the way the client imagines or wants? Sadly, social media has led to many rushed reunions, leading to relationship difficulties and heartbreak. Seeking a reunion via a Facebook post can cause stress and disappointment for both sides. It can also be difficult to process the information that may suddenly emerge as a result, such as the death or serious illness of birth family members. It is especially complex where family members were not aware of the existence of an adopted child, leading to possible rejection from birth siblings or other family members. A simple social media post can mean that life for many is changed forever. As in this case, we will come across the impact of adoption whether or not it is our chosen specialty, which is why I recommend that all therapists include a question about ‘any adoption in your family’ in their client assessment/intake. Even when adoption is not the reason for seeking therapy, wherever adoption issues are present, they create another layer to the work, and the effects will be felt. Without an awareness of and sensitivity to this, how can we do the best by our clients? For a greater understanding of the complexity of adoption, I recommend Lemn Sissay’s My Name is Why and Nancy Verrier’s The Primal Wound as good starting points. But most importantly, it is crucial therapists recognise the limits of their competence. I, for instance, choose not to work with eating disorders as I regard it as a specialised area for which I do not have sufficient training. If there is any doubt, it may be safer to refer the client on. Amanda Croft MBACP (Accred), Ofsted registered adoption counsellor with Barnardo’s, working with individuals, couples, children and young people

‘Is it respecting clients’ autonomy to regulate their choice of who they go to for counselling, simply because they are adopted?’ The legislation regarding working with adopted clients unfortunately can create fear and uncertainty within our profession, resulting in clients being refused therapy or therapy being terminated prematurely. I am not Ofsted

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registered but having both personal and professional experience in this field, I can only conclude the issue lies in the term ‘adoption’. If we replaced the word adoption with loss, separation or trauma, would we seek to refer on so readily? And if Ofsted regulation is necessary to protect clients, why is it OK for non-Ofsted registered counsellors to work with individuals who have had the experience of foster care? In my experience, clients whose primary focus is tracing their birth families tend to contact specialist agencies rather than counsellors. However, if in the process of counselling a client wants to explore issues around their adoption, as in this example, then we should be there to facilitate that. If the client then decides they want to trace their birth family, support from an ASA alongside the therapeutic relationship would be advisable. However, the client may find that their local ASA has limited capacity for counselling provision, so the continued support from the established therapeutic relationship will be essential. As for all clients, our focus should be on the individual needs of the client and what they bring to therapy, but with adoption, knowledge of attachment, loss and trauma are fundamental. All adopted clients have experienced some form of separation, loss or trauma, and care must be taken to enable clients to explore those early ruptures within a safe therapeutic frame. It is essential that loss and trauma are acknowledged and understood. If we negate the client’s experience, it can re-enact early abandonment, as can referring the client on or ceasing to work with them. One of the principles we adhere to in the Ethical Framework is ‘autonomy: respect for the client’s right to be self governing’ (Ethics, point 5). Is it respecting adult clients’ autonomy to regulate and limit their choice of who they go to for counselling, simply because they are adopted? Sue Fleming MBACP (Accred), counsellor in private practice and attachment trainer

‘Could the trauma of premature separation be reactivated by a forced end?’

As a practising psychotherapist with a clinical focus on the role of relationships in both creating and healing suffering, I would closely consider the relational context in which this dilemma has developed. Ten weeks into the work, a therapeutic relationship will be developing, forming the bond and attachment which the

client may be grieving. As Nancy Verrier says in The Primal Wound, could the trauma of premature separation from the birth mother be reactivated by a forced end with the therapist, especially when the work is incomplete? While I fully support the recognition that individuals affected by adoption should be provided with support and services from practitioners who hold proper qualifications and experience – which the change in law in 2010 was designed to ensure – I think it’s important to distinguish clearly between therapeutic support and support specifically in the context of the adoption process. Where the therapeutic experience is not revolving solely around the adoption itself – as in this case, where the client is working through ambivalence and whether to stay with their partner – why should the support and service end now? The amended legislation states that only counsellors and psychotherapists registered with an ASA can offer specialist adoption services. I believe more details of the ‘specialist’ factors that complete the registration process are required in helping inform the client, providing a clear separation between the two professionals. The client has started to explore their feelings about being adopted with a therapist who has presumably invested in the therapeutic relationship and subjective experience of the unique individual. If they are also committed to continued professional development in support of responding to specific relational injuries, as with any client group, aren’t they the most suitable person to hold this process? Verrier writes that the most common presentations with adopted people are abandonment, trust, loss and the need to mourn. Surely the current practitioner, who has most experience of the client’s emotional needs, is best placed to offer the space to explore these? At this stage of the work, could a recontracting process take place that clearly separates the two? The explorative work continues

The boundaries must be clear that, as counsellors, we will not be assisting in tracing the birth family, or advising the client about the merits of faceto-face meetings with birth relatives

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with the existing therapist, supporting the new feelings that are emerging, along with a referral to an ASA to support all those outside of the therapeutic relationship affected by the adoption process at every stage (adoptee, adopted family, birth family), should the family search go ahead. As with any change in frame, this process should be managed with care and transparency, allowing space and time for open dialogue, and providing all the information needed so the client can make an informed choice on how they want to move forward, without risk of feeling ‘dropped’. Kate Dryburgh MBACP, psychotherapist in private practice

‘They will benefit from the continued support of their current counsellor’

During our work as counsellors with individuals over time it is more than likely we will hear about experiences of adoption or fostering. It may emerge that a client we are working with has been or is an adoptive parent, had a relative who was adopted or, as in this case, has been adopted themselves. It is common for people who have relinquished or lost a child to adoption or fostering to seek counselling, and supporting them is very important work. However, when an adopted individual is seeking to trace their birth family, they will need to go through specific steps to find out that information, as Stephen Hitchcock has helpfully outlined. All local authorities and adoption agencies will have trained social workers ready to guide and help the individual to locate their details and prepare them with bespoke counselling for this important step. The process can be extremely unsettling and exciting for an individual at various points of the journey, and once embarked on, it is understandably hard to reverse. The client in the dilemma presented is clearly going through a complex period of indecision and uncertainty. In my view, they will benefit from the continued support of their current counsellor while they decide whether to trace their birth family. If they go ahead, then they will have a great deal to think about and consider. I see no reason why the counsellor cannot support them as they do this, particularly as they now have a positive, confiding relationship. However, the boundaries must be clear that, as counsellors, we will not be assisting in tracing the birth family, or advising them about

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the merits of face-to-face meetings with birth relatives. The therapist’s role is to support them through what will inevitably be a turbulent time. It must be made clear that they cannot comment on the work of the adoption agency with regard to aspects of the tracing, if that goes ahead. Importantly, it will be crucial for the counsellor to have supervision with a person who has experience and knowledge of adoption matters and their impact while they support the individual through the process. Elaine Rose, child and family psychotherapist

‘The counsellor needs to be cautious about how far they stray into adoption’

I’m often approached by therapists seeking clarification around this, and I would advise the counsellor to inform the client of the regulations and to refer on to specialist services. A fundamental principle is to assume the client will go forward with contacting their birth family, and will need a skilled therapist to help them navigate this. It can take a significant period of exploration before any contact is initiated. Working with the client, you hold the whole of the birth and adoptive family in mind, and the consequences, if rushed, can be longlasting and devastating. Screening for adoption during the initial session, when asking about family and relationship background, allows for a discussion before any meaningful therapeutic relationship begins. The client may have contact on their mind but may not think to explore it unless the therapist enquires explicitly. This allows for a direct referral at this early stage to an ASA such as Barnardo’s, who can recommend a list of counsellors registered to work with adoption. While the regulations state that you can work with a client on non-adoption issues, it is essential the client is informed that you will refer on if the work moves into adoption-related matters. But continuing to work with this client on non-adoption issues, with the view that they can be referred to an ASA if necessary, feels unsatisfactory and avoidant to me. The counsellor needs to be cautious about how far they stray into adoption, and if the client goes forward with contact, how could this be managed in the sessions? Previously contact was controlled by specialist social workers, managing

SUPPORT AND RESOURCES You can find more information and guidance in these BACP resources, which are all available online at www.bacp.co.uk/gpia:  Adoption law in England within the counselling professions (GPiA 003)  Adoption law in Wales and Northern Ireland within the counselling professions (GPiA 005)

expectations, and slowing the process down. Social media bypasses this and the process can escalate quickly, leaving an inexperienced therapist with complex issues beyond their scope. Unexpected contact can be destabilising for people who might be traumatised and vulnerable from their adoption experience. They can be left feeling they have no control or choice, which replicates the original dynamic around adoption. These are often the people I see in my practice, when contact hasn’t gone well and the consequences and feelings haven’t been thought through. While Ofsted states you can work with clients where adoption isn’t a central issue, I would argue that adoption should be a central issue for an adopted client, until it isn’t anymore. Therapy can activate feelings around early history, and adoption and relinquishment are

 Adoption law within the counselling professions in Scotland (GPiA 025)  Ethical decision making in the context of the counselling professions (GPiA 044)

significant aspects of this and should at least be thought about, as any significant early loss would be. If an adoptee wants to work on nonadoption issues, such as communicating with their partner or managing issues of stress at work, they shouldn’t be discriminated against when they seek support. But I also wonder whether adopted clients who don’t see their adoption as an issue have truly worked through their history? It might be a defence against the original loss, possibly impacting all subsequent attachments. If it feels off limits, how can a therapist understand its significance? Catherine Clouse MBACP, UKCP (Accred), Ofsted registered adoption counsellor with Barnardo’s and therapist in private practice

HOW WOULD YOU RESPOND? Do I still need 1.5 hours of supervision a month? I am a registered member of BACP and have worked as a counsellor in various agencies, services and private practice for 20 years. I feel confident with my therapeutic stance, what I offer and the kind of issues I work best with, and have invested a lot in CPD over the years. I am now winding down my practice as I plan to retire next year and am wondering why I still need 1.5 hours of supervision a month for one or two clients. Sometimes I find it hard to fill the time and we end up chatting, which is nice, but I do resent paying for it as it’s become a major percentage of my earnings. It feels like a tick-box exercise – is there any evidence that shows that everyone needs this amount of supervision? We welcome your responses to this upcoming dilemma. If you would like to contribute, please email the editor at therapytoday@thinkpublishing.co.uk for guidelines. The dilemma reported here is typical of those worked with by BACP’s Ethics Services. BACP members are entitled to access this consultation service free of charge. Appointments can be booked via the Ethics hub on the BACP website.

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Analyse Me, 1

The questionnaire VERSION

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What is your favourite piece of music and why? I love music, so

Linda Dubrow-Marshall speaks for herself

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What motivated you to become a therapist? I love being able to help

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people to use their own resources to overcome traumas and adverse experiences and to improve the quality of their lives. People say I have a calm demeanour and a good therapy voice, so that helps, and life experiences have taught me to be resilient.

Do you have a specialist field of practice? My most unique

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speciality is coercive control as experienced within abusive relationships and groups, including cults, and this is a real passion for me in practice, education and research. I am fortunate to work with my psychologist husband, Rod DubrowMarshall, in this area, and we have established the only MSc Psychology of Coercive Control programme in the world (at the University of Salford).

How has being a therapist changed you? I am honoured and

humbled to work with clients and am forever optimistic about their ability to change. Working with a range of clients, for example, in prisons, addiction rehabilitation centres, psychiatric hospitals, medical hospitals, university counselling services and in private practice, has deepened me as a person and made me appreciate the human spirit.

Where do you see yourself in five years’ time? Life is an adventure full

of surprises and I hope to be open to whatever opportunities come my way. What do you find challenging about being a therapist? Clients

rarely present with single problems and there are so many individual differences that I am always adapting how I work, which means I must cope with uncertainty and constantly re-evaluate how I am working. Supervision, consultation and working with others are so helpful.

And rewarding? Seeing people

move forward from abusive groups and relationships, watching people grow and develop, being surprised by client choices.

What is the most recent CPD you’ve undertaken? Was it worthwhile? A webinar on

What do you do for self-care/ to relax? I love to unwind and relax

with Rod at the end of a day, which can include talking, watching a good show and, very importantly, having a good laugh. Exercise is a good release from all the mental work that I do, and I love to read.

What is the meaning of life?

Finding meaning in life is the primary existential task that lasts a lifetime! For me, it is often very caught up with relationships and work, but there is great meaning in nature and simplicity and sitting quietly with oneself.

‘Compassion fatigue resilience: taking care of yourself while caring about others’, presented by Kerry Schwanz – definitely useful. Self-care for professionals is another area I am passionate about.

stand-up comedy in New York City and had the time of my life – I love making people laugh. It was also incredibly anxiety provoking!

What book/blog/podcast do you recommend most often?

Who is your counselling/ psychotherapy hero(ine)? Francine

Judith Herman’s book Trauma and Recovery is a classic. In it, she advocates for the diagnosis of complex post-traumatic stress and looks at the similar psychology of traumas across divergent contexts, as we do in the MSc Psychology of Coercive Control programme.

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it’s hard to choose, but I’m partial to Tchaikovsky’s Piano Concerto No. 1 as performed by Van Cliburn, which was one of my mother’s favourites. My mother died when I was a teenager, so it’s a lovely way to preserve a nice memory of her, and I love Nat King Cole for the same reason.

What would people be surprised to find out about you? I performed

Shapiro, who developed EMDR after a walk in the park where she was looking all around and felt better. She was one of my EMDR trainers and was passionate about researching EMDR, developing theoretical understandings, and humanitarian work. She was also humble.

About Linda Now: My private practice is now conducted online, which has allowed me to work with clients all over the world. My specialist practice related to coercive control is RETIRN (Re-entry Therapy, Information and Referral Network). I am also Head of Psychology at the University of Salford. Once was: Psychology research assistant. First paid job: As a teenager, my school asked me to tutor some students in the years below me. This sparked my appetite for teaching.

Who would you like to answer the questionnaire? Email your suggestions to therapytoday@ thinkpublishing.co.uk

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